title: Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis.
abstract: BACKGROUND
  Invasive pulmonary aspergillosis (IPA) is a life-threatening infection documented in up to 15% of hematology patients who require intensive care for acute respiratory failure. We report outcomes in hematology patients given mechanical ventilation (MV) with IPA.
  
  
  METHODS
  Retrospective study of all hematology patients given MV with IPA between January 1998 and March 2011 at a single center. Predictors of 6-month survival or mortality were identified using multivariable analysis.
  
  
  RESULTS
  We studied 67 patients including 49 (73%) with neutropenia, 23 (34%) with long-term steroid therapy, and 14 (21%) with allogeneic bone marrow transplantation. Incidence of IPA in the ICU decreased between 1998 and 2011, and mortality in patients receiving mechanical ventilation did not change. IPA was confirmed in 6 patients by autopsy and was probable in 61 patients based on host factors, clinical and radiographic features, and either Aspergillus isolation (50 patients) or Aspergillus antigen detection alone (11 patients). Concomitant bacterial infections were documented in 24 (36%) patients. ICU and 6-month mortality rates were 67 and 82%, respectively. Mortality was stable throughout the study period. Concomitant bacterial infection was independently associated with higher mortality [HR, 2.1 (1.2-3.8)]. Mortality was lower in patients given voriconazole [OR, 0.5 (0.3-0.9)].
  
  
  CONCLUSIONS
  Hospital mortality remains high in hematology patients requiring MV with IPA, particularly when concommittant infection occurred. The use of voriconazole improved survival.
authors.affiliation: AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France.
authors.forename: Gaston
authors.initials: G
authors.lastname: Burghi
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.forename: Amélie
authors.initials: A
authors.lastname: Seguin
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lambert
authors.forename: Claire
authors.initials: C
authors.lastname: Lacroix
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Moreau
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
authors.forename: David
authors.initials: D
authors.lastname: Schnell
authors.forename: Eric
authors.initials: E
authors.lastname: Mariotte
authors.forename: Benoît
authors.initials: B
authors.lastname: Schlemmer
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000328:Adult; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome