title: Factors associated with invasive lung aspergillosis and the significance of positive Aspergillus culture after liver transplantation.
abstract: From January 1981 to December 1990, 2180 patients underwent orthotopic liver transplantation at the University of Pittsburgh. Thirty-two patients (1.5%) were identified with invasive aspergillosis (29 lung, 2 intraabdominal, 1 meningitis). Of 29 patients with invasive lung disease, only 23 (79%) had positive culture (Aspergillus fumigatus, 20; Aspergillus flavus, 3). Forty-eight variables were analyzed and compared in 23 patients with invasive disease with positive cultures and 9 patients with colonization only. The variables associated with pulmonary invasive disease, by univariate analysis, were surgical time (P = .03), presence of laparotomies (P = .02), higher creatinine level at time of Aspergillus isolation (P = .01), and use of OKT3 (P = .02). However, in a multivariate analysis, only the last two (creatinine, OKT3) were associated with invasive lung aspergillosis. Of 4 patients with positive abdominal wound culture, 2 had local invasive aspergillosis. Therefore, positive cultures of Aspergillus organisms from respiratory secretions and wound drainage may represent invasive disease and should not be ignored.
authors.affiliation: Department of Surgery, University of Pittsburgh, Pennsylvania 15213.
authors.forename: S
authors.initials: S
authors.lastname: Kusne
authors.forename: J
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: R
authors.initials: R
authors.lastname: Mañez
authors.forename: W
authors.initials: W
authors.lastname: Irish
authors.forename: M
authors.initials: M
authors.lastname: Martin
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: R L
authors.initials: RL
authors.lastname: Simmons
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001228:Aspergillosis / Q000209:etiology* / Q000382:microbiology; D001230:Aspergillus / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008172:Lung Diseases, Fungal / Q000209:etiology* / Q000382:microbiology; D008297:Male; D015999:Multivariate Analysis; D010538:Peritonitis / Q000150:complications / Q000382:microbiology; D012137:Respiratory System / Q000382:microbiology; D013530:Surgical Wound Infection / Q000382:microbiology