title: Putative invasive pulmonary aspergillosis in critically ill patients with chronic obstructive pulmonary disease: a matched cohort study.
abstract: BACKGROUND
  Patients with advanced chronic obstructive pulmonary disease (COPD) are at risk for developing invasive pulmonary aspergillosis. A clinical algorithm has been validated to discriminate colonization from putative invasive pulmonary aspergillosis (PIPA) in Aspergillus-positive respiratory tract cultures of critically ill patients. We focused on critically ill patients with COPD who met the criteria for PIPA.
  
  
  METHODS
  This matched cohort study included critically ill patients with COPD from two university hospital intensive care units (ICUs). We studied the risk factors for PIPA as well as the impact of PIPA on short- and long-term outcomes. Whether PIPA was associated with a pattern of bacterial colonization and/or infection 6 months before and/or during ICU stay was assessed. In addition, antifungal strategies were reviewed.
  
  
  RESULTS
  Fifty cases of PIPA in critically ill patients with COPD in the ICU were matched with one hundred control patients with COPD. The ICU short- and the long-term (at 1 year) mortality were significantly increased in the PIPA group (p < 0.001 for all variables). PIPA was a strong independent risk factor for mortality in the ICU (odds ratio 7.44, 95 % confidence interval 2.93-18.93, p < 0.001) before vasopressor therapy, renal replacement therapy, and duration of mechanical ventilation. Before ICU admission, the use of corticosteroids and antibiotics significantly increased the risk of PIPA (p = 0.004 and p < 0.001, respectively). No significant difference in bacterial etiologic agents responsible for colonization and/or infection was found between the groups. Antifungal treatment was started in 64 % of PIPA cases, with a poor impact on the overall outcome.
  
  
  CONCLUSIONS
  PIPA was a strong death predictor in critically ill patients with COPD. The use of corticosteroids and antibiotics before ICU admission was a risk factor for PIPA. PIPA was not associated with a specific bacterial pattern of colonization or infection. Prompting antifungal treatment in critically ill patients with COPD who have PIPA may not be the only factor involved in prognosis reversal.
authors.affiliation: Département d'Anesthésie et de Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. claire.delsuc@gmail.com.
authors.forename: Claire
authors.initials: C
authors.lastname: Delsuc
authors.affiliation: Département de Réanimation médicale, Centre Hospitalier Régional Universitaire de Lille, Lille, France. aurelie.cottereau@ymail.com.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cottereau
authors.affiliation: Laboratoire de Parasitologie et de Mycologie médicale, Centre Hospitalier Régional Universitaire de Lille, Lille, France. emilie.frealle@gmail.com.
authors.forename: Emilie
authors.initials: E
authors.lastname: Frealle
authors.affiliation: Laboratoire de Parasitologie et de Mycologie médicale, Centre de Biologie Nord, Hospices Civils de Lyon, Lyon, France. anne-lise.bienvenu@chu-lyon.fr.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Bienvenu
authors.affiliation: Laboratoire de Bacteriologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France. rodrigue.dessein@chru-lille.fr.
authors.forename: Rodrigue
authors.initials: R
authors.lastname: Dessein
authors.affiliation: Département de Microbiologie, Centre de Biologie Est, Hospices Civils de Lyon, Bron, F-69677, France. sophie.jarraud@chu-lyon.fr.|Inserm U1111, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, Lyon, France. sophie.jarraud@chu-lyon.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Jarraud
authors.affiliation: Inserm U1111, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, Lyon, France. oana.dumitrescu@chu-lyon.fr.|Département de Microbiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, F-69495, France. oana.dumitrescu@chu-lyon.fr.
authors.forename: Oana
authors.initials: O
authors.lastname: Dumitrescu
authors.affiliation: Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC, Nancy, France. marion.le-marechal@univ-lorraine.fr.
authors.forename: Marion
authors.initials: M
authors.lastname: Le Maréchal
authors.affiliation: Département d'Anesthésiologie et de Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France. florent.wallet@chu-lyon.fr.
authors.forename: Florent
authors.initials: F
authors.lastname: Wallet
authors.affiliation: Département d'Anesthésiologie et de Réanimation, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France. arnaud.friggeri@chu-lyon.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Friggeri
authors.affiliation: Service de Réanimation médicale, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. laurent.argaud@chu-lyon.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.affiliation: Département d'Anesthésie et de Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. thomas.rimmele@chu-lyon.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rimmelé
authors.affiliation: Département de Réanimation médicale, Centre Hospitalier Régional Universitaire de Lille, Lille, France. saadalla.nseir@chru-lille.fr.|Faculté de Médecine, Université de Lille, Lille, France. saadalla.nseir@chru-lille.fr.
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
authors.affiliation: Inserm U1111, Centre International de Recherche en Infectiologie (CIRI), Université Claude Bernard Lyon 1, Lyon, France. florence.ader@chu-lyon.fr.|Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, F-69004, Lyon, France. florence.ader@chu-lyon.fr.|Département des Maladies Infectieuses et Tropicales, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande-Rue de la Croix-Rousse, 69317, Lyon cedex 04, France. florence.ader@chu-lyon.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Ader
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents