Outcome of ICU treatment in invasive aspergillosis.
OBJECTIVE
To assess the outcome of intensive care treatment in invasive aspergillosis.


METHODS
Retrospective study.


METHODS
University Hospital, Medical Intensive Care Unit (ICU).


METHODS
Twenty-five patients with invasive aspergillosis who were admitted to the medical ICU in a 5 1/2 year period. Twenty-two had received high-dose chemotherapy for (mainly hematologic) malignancies, one had been treated with cyclosporine and prednisolone for systemic lupus erythematosus, one with high-dose methylprednisolone for polyarteritis nodosa and one had an ARDS after near-drowning.


RESULTS
The medical records were reviewed for patient and disease characteristics, outcome, reasons for admission to the ICU, supportive care and antifungal therapy as well as for the results of cultures and autopsy. Out of 25 patients, a definite ante mortem diagnosis could be established in seven. When autopsied patients were included, a total of 15 suffered from proven invasive aspergillosis. Although standard antifungal treatment and maximal available supportive care were given, 23 of 25 patients (92%) died after a mean of 15 (1-51) days in the ICU. Both patients who recovered had received high-dose chemotherapy for hematologic malignancy and showed bone marrow recovery and/or had a localized pulmonary infection.


CONCLUSIONS
In patients with highly suspected or proven invasive aspergillosis, admission to an ICU and mechanical ventilation should be considered in cases of localized infection and obvious signs of hematologic recovery. In most other circumstances ICU admission for mechanical ventilation does not seem to improve survival.
Janssen
J J
JJ
Medical Intensive Care Unit, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.
Strack van Schijndel
R J
RJ
van der Poest Clement
E H
EH
Ossenkoppele
G J
GJ
Thijs
L G
LG
Huijgens
P C
PC
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D002423:Cause of Death; D003422:Critical Care; D003428:Cross Infection / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome