Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

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• 作者：Fabio Silvio Taccone (1)
  Anne-Marie Van den Abeele (2)
  Pierre Bulpa (3)
  Benoit Misset (4)
  Wouter Meersseman (5)
  Teresa Cardoso (6)
  Jos茅-Artur Paiva (7)
  Miguel Blasco-Navalpotro (8)
  Emmanuel De Laere (9)
  George Dimopoulos (10)
  Jordi Rello (11)
  Dirk Vogelaers (12)
  Stijn I Blot (12) (13)
  on behalf of the AspICU Study Investigators
  
  1. Department of Intensive Care Erasme Hospital ; Free University of Brussels ; Route de Lennik 808 ; 1070 ; Brussels ; Belgium
  2. Department of Microbiology General Hospital St. Lucas ; Groenebriel 1 ; 9000 ; Ghent ; Belgium
  3. Department of Intensive Care Mont-Godinne University Hospital ; Catholic University of Louvain ; Avenue G.Th茅rasse 1 ; 5530 ; Yvoir ; Belgium
  4. Department of Intensive Care Foundation Hospital Saint-Joseph ; Paris-Descartes University ; 185 Rue Raymond Losserand ; 75014 ; Paris ; France
  5. Medical Intensive Care Unit ; University Hospital Leuven ; Herestraat 49 ; 3000 ; Leuven ; Belgium
  6. Department of Intensive Care ; Santo Antonio Hospital ; Largo Prof. Abel Salazar ; 4099-001 ; Porto ; Portugal
  7. Department of Emergency and Intensive Care ; Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hern芒ni Monteiro ; 4200-319 ; Porto ; Portugal
  8. Department of Intensive Care ; University Hospital Severo Ochoa ; Avenida de Orellana ; s/n 28911 ; Legan茅s ; Madrid ; Spain
  9. Department of Microbiology ; General Hospital Delta ; Brugsesteenweg 90 ; 8800 ; Roeselare ; Belgium
  10. Department of Critical Care Medicine ; Attikon University Hospital ; University of Athens Medical School ; 1 Rimini Street ; Haidari ; 124 62 ; Athens ; Greece
  11. Hospital Universitari Vall d鈥橦ebron ; Vall D鈥橦ebron ; Institute of Research ; CIBERES ; Autonomous University of Barcelona ; Passeig Vall d鈥橦ebron ; 119-129 ; 08035 ; Barcelona ; Spain
  12. Department of Internal Medicine Faculty of Medicine & Health Science ; Ghent University ; De Pintelaan 185 ; 9000 ; Ghent ; Belgium
  13. Burns ; Trauma ; and Critical Care Research Centre ; The University of Queensland ; Butterfield Street ; Herston (Brisbane) ; 4006 ; Queensland ; Australia
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：691 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. Methods An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Results A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incidences of cancer and organ transplantation than those with colonization. Compared with other patients, they were more frequently diagnosed with sepsis on ICU admission and more frequently received vasopressors and renal replacement therapy (RRT) during the ICU stay. Mortality was 38% among colonized patients, 67% in those with putative IA and 79% in those with proven IA (P鈥?鈥?.001). Independent risk factors for death among patients with IA included older age, history of bone marrow transplantation, and mechanical ventilation, RRT and higher Sequential Organ Failure Assessment score at diagnosis. Conclusions IA among critically ill patients is associated with high mortality. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with Aspergillus spp colonization.