Isolation of Aspergillusspp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome

Garnacho-Montero José, Amaya-Villar Rosario, Ortiz-Leyba Carlos, León Cristobal, Álvarez-Lerma Francisco, Nolla-Salas Juan, Iruretagoyena, Barcenilla, Barcenilla Fernando

Description

Our aims were to assess risk factors, clinical features, management and outcomes in critically ill patients in whom Aspergillus spp. were isolated from respiratory secretions, using a database from a study designed to assess fungal infections. Methods A multicentre prospective study was conducted over a 9-month period in 73 intensive care units (ICUs) and included patients with an ICU stay longer than 7 days. Tracheal aspirate and urine samples, and oropharyngeal and gastric swabs were collected and cultured each week. On admission to the ICU and at the initiation of antifungal therapy, the severity of illness was evaluated using the Acute Physiology and Chronic Health Evaluation II score. Retrospectively, isolation of Aspergillus spp. was considered to reflect colonization if the patient did not fulfil criteria for pneumonia, and infection if the patient met criteria for pulmonary infection and if the clinician in charge considered the isolation to be clinically valuable. Risk factors, antifungal use and duration of therapy were noted. Results Out of a total of 1756 patients, Aspergillus spp. were recovered in 36. Treatment with steroids (odds ratio = 4.5) and chronic obstructive pulmonary disease (odds ratio = 2.9) were significantly associated with Aspergillus spp. isolation in multivariate analysis. In 14 patients isolation of Aspergillus spp. was interpreted as colonization, in 20 it was interpreted as invasive aspergillosis, and two cases were not classified. The mortality rates were 50% in the colonization group and 80% in the invasive infection group. Autopsy was performed in five patients with clinically suspected infection and confirmed the diagnosis in all of these cases. Conclusion In critically ill patients, treatment should be considered if features of pulmonary infection are present and Aspergillus spp. are isolated from respiratory secretions.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2005
• Nombre de lectures: 0
• Langue: English

Extrait

Available onlinehttp://ccforum.com/content/9/3/R191

Vol 9 No 3 Open Access Research Isolation ofAspergillusspp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome 1 23 4 José GarnachoMontero, Rosario AmayaVillar, Carlos OrtizLeyba, Cristóbal León, 5 67 8 Francisco ÁlvarezLerma, Juan NollaSalas, José R Iruretagoyenaand Fernando Barcenilla

1 Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain 2 Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain 3 Department of Intensive Care Medicine, Hospital Universitario Virgen del Rocío, Sevilla, Spain 4 Department of Intensive Care Medicine, Hospital Universitario de Valme, Sevilla, Spain 5 Department of Intensive Care Medicine, Hospital Universitari del Mar, Barcelona, Spain 6 Department of Intensive Care Medicine, Hospital Universitari del Mar, Barcelona, Spain 7 Department of Intensive Care Medicine, Hospital de Cruces, Bilbao, Bikzakia, Spain 8 Department of Intensive Care Medicine, Hopsital Universitari Arnau de Vilanova, Lleida, Spain Corresponding author: José GarnachoMontero, [e-mail] Received: 30 Nov 2004Revisions requested: 29 Dec 2004Revisions received: 19 Jan 2004Accepted: 2 Feb 2005Published: 11 Mar 2005 Critical Care2005,9:R191R199 (DOI 10.1186/cc3488) This article is online at: http://ccforum.com/content/9/3/R191 © 2005 GarnachoMonteroet al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/ 2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Introduction Ouraims were to assess risk factors, clinical features, management and outcomes in critically ill patients in whomAspergillusspp. were isolated from respiratory secretions, using a database from a study designed to assess fungal infections.

MethodsA multicentre prospective study was conducted over a 9month period in 73 intensive care units (ICUs) and included patients with an ICU stay longer than 7 days. Tracheal aspirate and urine samples, and oropharyngeal and gastric swabs were collected and cultured each week. On admission to the ICU and at the initiation of antifungal therapy, the severity of illness was evaluated using the Acute Physiology and Chronic Health Evaluation II score. Retrospectively, isolation ofAspergillusspp. was considered to reflect colonization if the patient did not fulfil criteria for pneumonia, and infection if the patient met criteria for pulmonary infection and if the clinician in charge considered the

Introduction Aspergillusis a genus of mitosporic fungi, some species of which are known to cause infections in humans, particularly Aspergillus fumigatus(85% of cases) followed byA flavus andA niger[1].Aspergillusspp. are responsible for a broad spectrum of illnesses, from saprophytic colonization of the bronchial tree to rapidly invasive and disseminated diseases. Invasive aspergillosis remains a major cause of morbidity and

isolation to be clinically valuable. Risk factors, antifungal use and duration of therapy were noted.

ResultsOut of a total of 1756 patients,Aspergillusspp. were recovered in 36. Treatment with steroids (odds ratio = 4.5) and chronic obstructive pulmonary disease (odds ratio = 2.9) were significantly associated withAspergillusspp. isolation in multivariate analysis. In 14 patients isolation ofAspergillusspp. was interpreted as colonization, in 20 it was interpreted as invasive aspergillosis, and two cases were not classified. The mortality rates were 50% in the colonization group and 80% in the invasive infection group. Autopsy was performed in five patients with clinically suspected infection and confirmed the diagnosis in all of these cases.

Conclusioncritically ill patients, treatment should be In considered if features of pulmonary infection are present and Aspergillusspp. are isolated from respiratory secretions.

mortality in immunosuppressed patients with profound granu locytopenia secondary to haematological malignancies, or solid organ and bone marrow transplantation. Outbreaks of aspergillosis in patients admitted to intensive care units (ICUs) have been reported [2].Aspergillusspp. can also cause pneu monia in ICU patients without classical predisposing factors, as well as communityacquired pneumonia in otherwise immu nocompetent healthy individuals [3,4].

APACHE = Acute Physiology and Chronic Health Evaluation; CI = confidence interval; COPD = chronic obstructive pulmonary disease; ICU = inten sive care unit; OR = odds ratio. R191