[Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the intensive care units].
The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality.


OBJECTIVE
To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection.


METHODS
An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis.


RESULTS
A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76).


CONCLUSIONS
Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España. Electronic address: Falvarez@parcdesalutmar.cat.
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F
Álvarez Lerma
Servicio de Medicina Intensiva, Hospital de Galdakao, Galdakao, España.
P
P
Olaechea Astigarraga
Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Lleida, España.
M
M
Palomar Martínez
Servicio de Medicina Intensiva, Hospital General de Huelva Juan Ramón Jiménez, Huelva, España.
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M
Rodríguez Carvajal
Servicio de Medicina Intensiva, Complejo Hospitalario de Jaén, Jaén, España.
J F
JF
Machado Casas
Unidad de Cuidados Intensivos, Hospital Médico-Quirúrgico Virgen de las Nieves, Granada, España.
M M
MM
Jiménez Quintana
Servicio de Medicina Intensiva, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, España.
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F
Esteve Urbano
Servicio de Medicina Intensiva, Hospital Clínico de Salamanca, Salamanca, España.
J C
JC
Ballesteros Herráez
Unidad de Cuidados Intensivos Quirúrgica, Hospital Clinic i Provincial, IDIBAPS, Barcelona, España.
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Zavala Zegarra
D018806:APACHE; D000368:Aged; D015897:Comorbidity; D016638:Critical Illness; D003953:Diagnosis-Related Groups; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology; D013030:Spain
Aspergillus spp.; Aspergillus spp., Critically ill patientl; Fungal respiratory infection; Infección respiratoria por hongos; Intensive care unit; Mortalidad; Mortality; Paciente crítico; Unidad de cuidados intensivos