title: Invasive fungal tracheobronchitis in mechanically ventilated critically ill patients: underlying conditions, diagnosis, and outcomes.
abstract: BACKGROUND
  Invasive fungal tracheobronchitis (IFT) is a severe form of pulmonary fungal infection that is not limited to immunocompromised patients. Although respiratory failure is a crucial predictor of death, information regarding IFT in critically ill patients is limited.
  
  
  METHODS
  In this retrospective, multicenter, observational study, we enrolled adults diagnosed as having IFT who had been admitted to the intensive care unit between January 2007 and December 2015. Their demographics, clinical imaging data, bronchoscopic and histopathological findings, and outcomes were recorded.
  
  
  RESULTS
  This study included 31 patients who had been diagnosed as having IFT, comprising 24 men and 7 women with a mean age of 64.7 ± 13.7 years. All patients developed respiratory failure and received mechanical ventilation before diagnosis. Eighteen (58.1%) patients had diabetes mellitus, and 12 (38.7%) had chronic lung disease. Four (12.9%) patients had hematologic disease, and none of the patients had neutropenia. Twenty-five (80.6%) patients were diagnosed as having proven IFT, and the remaining patients had probable IFT. Aspergillus spp. (61.3%) were the most common pathogenic species, followed by Mucorales (25.8%) and Candida spp. (6.5%). The diagnoses in six (19.4%) patients were confirmed only through bronchial biopsy and histopathological examination, whereas their cultures of bronchoalveolar lavage fluid were negative for fungi. The overall in-hospital mortality rate was 93.5%.
  
  
  CONCLUSIONS
  IFT in critically ill patients results in a high mortality rate. Diabetes mellitus is the most prevalent underlying disease, followed by chronic lung disease. In addition to Aspergillus spp., Mucorales is another crucial pathogenic species. Bronchial lesion biopsy is the key diagnostic strategy.
authors.affiliation: Department of General Medicine and Geriatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.|College of Health Sciences, Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan.|College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Liu
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
authors.forename: Che-Chia
authors.initials: CC
authors.lastname: Chang
authors.affiliation: Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Hou-Tai
authors.initials: HT
authors.lastname: Chang
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Han-Chung
authors.initials: HC
authors.lastname: Hu
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Kao
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ning-Hung
authors.initials: NH
authors.lastname: Chen
authors.affiliation: Department of General Medicine and Geriatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ying-Jen
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Yang
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. cch4848@cloud.cgmh.org.tw.|College of Medicine, Chang Gung University, Taoyuan, Taiwan. cch4848@cloud.cgmh.org.tw.
authors.forename: Chung-Chi
authors.initials: CC
authors.lastname: Huang
authors.affiliation: Department of Critical Care, ATTIKON University Hospital, University of Athens, Medical School, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
keywords: Aspergillosis; Critical care; Invasive fungal tracheobronchitis; Mucormycosis; Outcome