title: Aspergillus in the lower respiratory tract of immunocompetent critically ill patients.
abstract: OBJECTIVE
  To shed light on the meaning of Aspergillus-positive lower-respiratory-tract samples in non immunocompromized critically ill patients.
  
  
  METHODS
  Multicentre matched case-control (1:5) study. We used prospectively collected data to identify risk factors for Aspergillus-positive specimens, as well as outcomes in Aspergillus-positive patients.
  
  
  RESULTS
  66 cases (5 with definite invasive pulmonary aspergillosis (IPA), 18 with probable IPA, and 43 colonisations) were matched to 330 controls. In the multivariate conditional logistic model, independent risk factors for at least one Aspergillus-positive respiratory-tract specimen were worse SAPSII at admission [OR, 1.10; 95%CI, 1.00-1.21], ARDS [OR, 2.64; 95%CI, 1.29-5.40]; long-term steroid therapy [OR, 4.77; 95%CI, 1.49-15.23]; steroid therapy started in the ICU [OR, 11.03; 95%CI, 4.40-27.67]; and bacterial infection [OR, 2.73; 95%CI, 1.37-5.42]. The risk of death, compared to the controls, was not higher in the cases overall [HR, 0.66; 95%CI, 0.41-1.08; p = 0.1] or in the subgroups with definite IPA [HR, 1.60; 95%CI, 0.43-5.94; p = 0.48], probable IPA [HR, 0.84; 95%CI, 0.28-2.50; p = 0.76], or colonisation [HR, 0.58; 95%CI, 0.33-1.02; p = 0.06]. In cases who received antifungal therapy, mortality was not lower than in untreated cases [HR, 0.67; 95%CI, 0.36-1.24; p = 0.20].
  
  
  CONCLUSIONS
  In critically ill immunocompetent patients, risk factors for presence of Aspergillus in lower respiratory tract specimens are steroid therapy (either chronic or initiated in the ICU), ARDS, and high severity of the acute illness. Prospective studies are warranted to further examine these risk factors and to investigate immune functions as well as the impact of antifungal therapy on patient outcomes.
authors.affiliation: Medical Intensive Care Unit, Research Group on Acute Respiratory Failure in Hematology and Oncology Patients, Saint-Louis Hospital and Paris 7 Denis Diderot University, Paris, France; Grenoble 1 University, Medical Intensive Care Unit, Albert Michallon University Hospital, Grenoble, France; Grenoble 1 University, Albert Bonniot Institute, Team 11: Outcome of Airway Cancers and Mechanically Ventilated Patients, Grenoble, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Lugosi
authors.affiliation: Epidemiologic Clinical Unit, INSERM, Robert Debre Hospital and Paris 7 Denis Diderot University, Paris, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.affiliation: Bacteriological-Virological Unit, Necker Hospital and Paris 5 René Descartes University, Paris, France.
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Intensive Care Unit, Saint-Joseph Hospital, Paris, France; Grenoble 1 University, Albert Bonniot Institute, Team 11: Outcome of Airway Cancers and Mechanically Ventilated Patients, Grenoble, France.
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste
authors.affiliation: Medical Intensive Care Unit, Research Group on Acute Respiratory Failure in Hematology and Oncology Patients, Saint-Louis Hospital and Paris 7 Denis Diderot University, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.affiliation: Surgical Intensive Care Unit, Antoine Béclère Hospital, Clamart, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Descorps-Desclère
authors.affiliation: Intensive Care Unit, Louis Mourier Hospital, Colombes, France.
authors.forename: Jean-Damien
authors.initials: JD
authors.lastname: Ricard
authors.affiliation: Intensive Care Unit, Gonesse Hospital, Gonesse, France.
authors.forename: Dany
authors.initials: D
authors.lastname: Goldgran-Tolédano
authors.affiliation: Surgical Intensive Care Unit, Avicenne Hospital and Paris 13 University, Bobigny, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: Grenoble 1 University, Medical Intensive Care Unit, Albert Michallon University Hospital, Grenoble, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.affiliation: Grenoble 1 University, Albert Bonniot Institute, Team 11: Outcome of Airway Cancers and Mechanically Ventilated Patients, Grenoble, France; Biostatistical Department, Outcomerea Organisation, Paris, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vésin
authors.affiliation: Grenoble 1 University, Medical Intensive Care Unit, Albert Michallon University Hospital, Grenoble, France; Grenoble 1 University, Albert Bonniot Institute, Team 11: Outcome of Airway Cancers and Mechanically Ventilated Patients, Grenoble, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.affiliation: Medical Intensive Care Unit, Research Group on Acute Respiratory Failure in Hematology and Oncology Patients, Saint-Louis Hospital and Paris 7 Denis Diderot University, Paris, France. Electronic address: elie.azoulay@sls.aphp.fr.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006801:Humans; D007121:Immunocompetence; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013256:Steroids / Q000009:adverse effects*
chemical_list: D013256:Steroids
keywords: ARDS; Aspergillus; Bacterial infection; Immunocompromized; Mechanical ventilation