Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes.
BACKGROUND
Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting.


METHODS
An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation.


RESULTS
A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incidences of cancer and organ transplantation than those with colonization. Compared with other patients, they were more frequently diagnosed with sepsis on ICU admission and more frequently received vasopressors and renal replacement therapy (RRT) during the ICU stay. Mortality was 38% among colonized patients, 67% in those with putative IA and 79% in those with proven IA (P < 0.001). Independent risk factors for death among patients with IA included older age, history of bone marrow transplantation, and mechanical ventilation, RRT and higher Sequential Organ Failure Assessment score at diagnosis.


CONCLUSIONS
IA among critically ill patients is associated with high mortality. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with Aspergillus spp colonization.
Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be.
Fabio Silvio
FS
Taccone
Department of Microbiology General Hospital St. Lucas, Groenebriel 1, 9000, Ghent, Belgium. anne-marie.vandenabeele@azstlucas.be.
Anne-Marie
AM
Van den Abeele
Department of Intensive Care Mont-Godinne University Hospital, Catholic University of Louvain, Avenue G.Thérasse 1, 5530, Yvoir, Belgium. pierre.bulpa@aclouvain.be.
Pierre
P
Bulpa
Department of Intensive Care Foundation Hospital Saint-Joseph, Paris-Descartes University, 185 Rue Raymond Losserand, 75014, Paris, France. bmisset@hpsj.fr.
Benoit
B
Misset
Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium. wouter.meersseman@uzleuven.be.
Wouter
W
Meersseman
Department of Intensive Care, Santo Antonio Hospital, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal. cardoso.tmc@gmail.com.
Teresa
T
Cardoso
Department of Emergency and Intensive Care, Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal. jarturpaiva@gmail.com.
José-Artur
JA
Paiva
Department of Intensive Care, University Hospital Severo Ochoa, Avenida de Orellana, s/n 28911, Leganés, Madrid, Spain. mblasco.hsvo@salud.madrid.org.
Miguel
M
Blasco-Navalpotro
Department of Microbiology, General Hospital Delta, Brugsesteenweg 90, 8800, Roeselare, Belgium. emmanuel.delaere@azdelta.be.
Emmanuel
E
De Laere
Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Haidari, 124 62, Athens, Greece. gdimop@med.uoa.gr.
George
G
Dimopoulos
Hospital Universitari Vall d'Hebron, Vall D'Hebron, Institute of Research, CIBERES, Autonomous University of Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain. jrello@crips.es.
Jordi
J
Rello
Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. dirk.vogelaers@uzgent.be.
Dirk
D
Vogelaers
Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. stijn.blot@ugent.be.|Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Butterfield Street, Herston (Brisbane), 4006, Queensland, Australia. stijn.blot@ugent.be.
Stijn I
SI
Blot
D000328:Adult; D000368:Aged; D015897:Comorbidity; D016638:Critical Illness; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000401:mortality; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects; D012307:Risk Factors