Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

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• 作者：Fabio Silvio Taccone (1)
  Anne-Marie Van den Abeele (2)
  Pierre Bulpa (3)
  Benoit Misset (4)
  Wouter Meersseman (5)
  Teresa Cardoso (6)
  Jos茅-Artur Paiva (7)
  Miguel Blasco-Navalpotro (8)
  Emmanuel De Laere (9)
  George Dimopoulos (10)
  Jordi Rello (11)
  Dirk Vogelaers (12)
  Stijn I Blot (12) (13)
  on behalf of the AspICU Study Investigators
  
  1. Department of Intensive Care Erasme Hospital ; Free University of Brussels ; Route de Lennik 808 ; 1070 ; Brussels ; Belgium
  2. Department of Microbiology General Hospital St. Lucas ; Groenebriel 1 ; 9000 ; Ghent ; Belgium
  3. Department of Intensive Care Mont-Godinne University Hospital ; Catholic University of Louvain ; Avenue G.Th茅rasse 1 ; 5530 ; Yvoir ; Belgium
  4. Department of Intensive Care Foundation Hospital Saint-Joseph ; Paris-Descartes University ; 185 Rue Raymond Losserand ; 75014 ; Paris ; France
  5. Medical Intensive Care Unit ; University Hospital Leuven ; Herestraat 49 ; 3000 ; Leuven ; Belgium
  6. Department of Intensive Care ; Santo Antonio Hospital ; Largo Prof. Abel Salazar ; 4099-001 ; Porto ; Portugal
  7. Department of Emergency and Intensive Care ; Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hern芒ni Monteiro ; 4200-319 ; Porto ; Portugal
  8. Department of Intensive Care ; University Hospital Severo Ochoa ; Avenida de Orellana ; s/n 28911 ; Legan茅s ; Madrid ; Spain
  9. Department of Microbiology ; General Hospital Delta ; Brugsesteenweg 90 ; 8800 ; Roeselare ; Belgium
  10. Department of Critical Care Medicine ; Attikon University Hospital ; University of Athens Medical School ; 1 Rimini Street ; Haidari ; 124 62 ; Athens ; Greece
  11. Hospital Universitari Vall d鈥橦ebron ; Vall D鈥橦ebron ; Institute of Research ; CIBERES ; Autonomous University of Barcelona ; Passeig Vall d鈥橦ebron ; 119-129 ; 08035 ; Barcelona ; Spain
  12. Department of Internal Medicine Faculty of Medicine & Health Science ; Ghent University ; De Pintelaan 185 ; 9000 ; Ghent ; Belgium
  13. Burns ; Trauma ; and Critical Care Research Centre ; The University of Queensland ; Butterfield Street ; Herston (Brisbane) ; 4006 ; Queensland ; Australia
  
• 刊名：Critical Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：19
• 期：1
• 全文大小：691 KB
• 参考文献：1. Meersseman, W, Wijngaerden, E (2007) Invasive aspergillosis in the ICU: an emerging disease. Intensive Care Med. 33: pp. 1679-81 CrossRef
  2. Auberger, J, Lass-Fl枚rl, C, Ulmer, H, Nogler-Semenitz, E, Clausen, J, Gunsilius, E (2008) Significant alterations in the epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. Int J Hematol. 88: pp. 508-15 185-008-0184-2" target="_blank" title="It opens in new window">CrossRef
  3. Eriksson, M, Lemstr枚m, K, Suojaranta-Ylinen, R, Martelius, T, Harjula, A, Sipponen, J (2010) Control of early Aspergillus mortality after lung transplantation: outcome and risk factors. Transplant Proc. 42: pp. 4459-64 CrossRef
  4. Lugosi, M, Alberti, C, Zahar, JR, Garrouste, M, Lemiale, V, Descorps-Descl猫re, A (2014) Aspergillus in the lower respiratory tract of immunocompetent critically ill patients. J Infect. 69: pp. 284-92 CrossRef
  5. Meersseman, W, Lagrou, K, Maertens, J, Wilmer, A, Hermans, G, Vanderschueren, S (2008) Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med. 177: pp. 27-34 CrossRef
  6. Khasawneh, F, Mohamad, T, Moughrabieh, MK, Lai, Z, Ager, J, Soubani, AO (2006) Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome. J Crit Care. 21: pp. 322-7 CrossRef
  7. Garnacho-Montero, J, Amaya-Villar, R, Ortiz-Leyba, C, Le贸n, C, Alvarez-Lerma, F, Nolla-Salas, J (2005) Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome. Crit Care 9: pp. R191-9 CrossRef
  8. Vandewoude, K, Blot, S, Benoit, D, Depuydt, P, Vogelaers, D, Colardyn, F (2004) Invasive aspergillosis in critically ill patients: analysis of risk factors for acquisition and mortality. Acta Clin Belg. 59: pp. 251-7 CrossRef
  9. Pauw, B, Walsh, TJ, Donnelly, JP, Stevens, DA, Edwards, JE, Calandra, T (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 46: pp. 1813-21 CrossRef
  10. Vincent, JL, Sakr, Y, Sprung, CL, Ranieri, VM, Reinhart, K, Gerlach, H (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. 34: pp. 344-53 CrossRef
  11. Petri, MG, K枚nig, J, Moecke, HP, Gramm, HJ, Barkow, H, Kujath, P (1997) Paul-Ehrlich Society for Chemotherapy, Divisions of Mycology and Pneumonia Research. Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med 23: pp. 317-25 CrossRef
  12. Blot, S, Charles, PE (2013) Fungal sepsis in the ICU: are we doing better? Trends in incidence, diagnosis, and outcome. Minerva Anestesiol. 79: pp. 1396-405
  13. Montagna, MT, Caggiano, G, Lovero, G, Giglio, O, Coretti, C, Cuna, T (2014) Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA Project). Infection. 42: pp. 141-51 CrossRef
  14. Meersseman, W, Vandecasteele, SJ, Wilmer, A, Verbeken, E, Peetermans, WE, Wijngaerden, E (2004) Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med. 170: pp. 621-5 CrossRef
  15. Dimopoulos, G, Piagnerelli, M, Berr茅, J, Eddafali, B, Salmon, I, Vincent, JL (2003) Disseminated aspergillosis in intensive care unit patients: an autopsy study. J Chemother. 15: pp. 71-5 CrossRef
  16. Vandewoude, KH, Blot, SI, Depuydt, P, Benoit, D, Temmerman, W, Colardyn, F (2006) Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients. Crit Care. 10: pp. R31 CrossRef
  17. Levy, H, Horak, DA, Tegtmeier, BR, Yokota, SB, Forman, SJ (1992) The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med. 86: pp. 243-8 CrossRef
  18. Baddley, JW, Stephens, JM, Ji, X, Gao, X, Schlamm, HT, Tarallo, M (2013) Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes. BMC Infect Dis. 13: pp. 29 CrossRef
  19. Donati, DY, Papazian, L (2008) Role of open-lung biopsy in acute respiratory distress syndrome. Curr Opin Crit Care. 14: pp. 75-9 CrossRef
  20. Koulenti, D, Garnacho-Montero, J, Blot, S (2014) Approach to invasive pulmonary aspergillosis in critically ill patients. Curr Opin Infect Dis. 27: pp. 174-83 CrossRef
  21. Koulenti, D, Vogelaers, D, Blot, S (2014) What鈥檚 new in invasive pulmonary aspergillosis in the critically ill?. Intensive Care Med. 40: pp. 723-6 CrossRef
  22. He, H, Ding, L, Chang, S, Li, F, Zhan, Q (2011) Value of consecutive galactomannan determinations for the diagnosis and prognosis of invasive pulmonary aspergillosis in critically ill chronic obstructive pulmonary disease. Med Mycol. 49: pp. 345-51 CrossRef
  23. Blot, SI, Taccone, FS, Abeele, AM, Bulpa, P, Meersseman, W, Brusselaers, N (2012) A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 186: pp. 56-64 CrossRef
  24. AspICU2 Project. http://www.aspicu2.org/. Accessed 31 January 2015.
  25. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE (1985) APACHE II: a severity of disease classification system. Crit Care Med. 13: pp. 818-29 CrossRef
  26. Vincent, JL, Moreno, R, Takala, J, Willatts, S, Mendon莽a, A, Bruining, H (1996) on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22: pp. 707-10 CrossRef
  27. Bernard, GR, Artigas, A, Brigham, KL, Carlet, J, Falke, K, Hudson, L (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149: pp. 818-24 CrossRef
  28. Levy, MM, Fink, MP, Marshall, JC, Abraham, E, Angus, D, Cook, D (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 31: pp. 1250-6 CrossRef
  29. Ascioglu, S, Rex, JH, Pauw, B, Bennett, JE, Bille, J, Crokaert, F (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis. 34: pp. 7-14 CrossRef
  30. Barberan, J, Alcazar, B, Malmierca, E (2012) Garcia de la Llana F, Dorca J, del Castillo D, et al. Repeated Aspergillus isolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection?. BMC Infect Dis. 12: pp. 295 CrossRef
  31. Tortorano, AM, Dho, G, Prigitano, A, Breda, G, Grancini, A, Emmi, V (2012) Invasive fungal infections in the intensive care unit: a multicentre, prospective, observational study in Italy (2006鈥?008). Mycoses. 55: pp. 73-9 CrossRef
  32. Petri, MG, K枚nig, J, Moecke, HP, Gramm, HJ, Barkow, H, Kujath, P (1997) Epidemiology of invasive mycosis in ICU patients: a prospective multicenter study in 435 non-neutropenic patients. Intensive Care Med. 23: pp. 317-25 CrossRef
  33. Spapen, H, Spapen, J, Taccone, FS, Meersseman, W, Rello, J, Dimopoulos, G (2014) Cerebral aspergillosis in adult critically ill patients: a descriptive report of 10 patients from the AspICU cohort. Int J Antimicrob Agents. 43: pp. 165-9 CrossRef
  34. Baddley, JW, Stroud, TP, Salzman, D, Pappas, PG (2001) Invasive mold infections in allogeneic bone marrow transplant recipients. Clin Infect Dis. 32: pp. 1319-24 CrossRef
  35. Baddley, JW, Andes, DR, Marr, KA, Kontoyiannis, DP, Alexander, BD, Kauffman, CA (2010) Factors associated with mortality in transplant patients with invasive aspergillosis. Clin Infect Dis. 50: pp. 1559-67 CrossRef
  36. Bouza, E, Guinea, J, Pel谩ez, T, P茅rez-Molina, J, Alcal谩, L, Mu帽oz, P (2005) Workload due to Aspergillus fumigatus and significance of the organism in the microbiology laboratory of a general hospital. J Clin Microbiol. 43: pp. 2075-9 CrossRef
  37. Burghi, G, Lemiale, V, Seguin, A, Lambert, J, Lacroix, C, Canet, E (2011) Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis. Intensive Care Med. 37: pp. 1605-12 CrossRef
  38. Bulpa, PA, Dive, AM, Garrino, MG, Delos, MA, Gonzalez, MR, Evrard, PA (2001) Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?. Intensive Care Med. 27: pp. 59-67 CrossRef
  39. Gustot, T, Maillart, E, Bocci, M, Surin, R, Tr茅po, E, Degr茅, D (2014) Invasive aspergillosis in patients with severe alcoholic hepatitis. J Hepatol. 60: pp. 267-74 CrossRef
  40. Guinea, J, Torres-Narbona, M, Gij贸n, P, Mu帽oz, P, Pozo, F, Pel谩ez, T (2010) Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect. 16: pp. 870-7 CrossRef
  41. Barberan, J, Sanz, F, Hernandez, JL, Merlos, S, Malmierca, E, Garcia-Perez, FJ (2012) Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by GOLD stage. J Infect 65: pp. 447-52 CrossRef
  42. Ader, F, Nseir, S, Berre, R, Leroy, S, Tillie-Leblond, I, Marquette, CH (2005) Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen. Clin Microbiol Infect. 11: pp. 427-9 CrossRef
  43. Marr, KA, Carter, RA, Crippa, F, Wald, A, Corey, L (2002) Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 34: pp. 909-17 CrossRef
  44. Falcone, M, Massetti, AP, Russo, A, Vullo, V, Venditti, M (2011) Invasive aspergillosis in patients with liver disease. Med Mycol. 49: pp. 406-13 CrossRef
  45. Hartemink, KJ, Paul, MA, Spijkstra, JJ, Girbes, AR, Polderman, KH (2003) Immunoparalysis as a cause for invasive aspergillosis?. Intensive Care Med. 29: pp. 2068-71 CrossRef
  46. Wauters, J, Baar, I, Meersseman, P, Meersseman, W, Dams, K, Paep, R (2012) Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study. Intensive Care Med. 38: pp. 1761-8 CrossRef
  47. Janssen, JJ (1996) Strack van Schijndel RJ, van der Poest Clement EH, Ossenkoppele GJ, Thijs LG. Huijgens PC. Outcome of ICU treatment in invasive aspergillosis. Intensive Care Med. 22: pp. 1315-22
  48. Kim, A, Nicolau, DP, Kuti, JL (2011) Hospital costs and outcomes among intravenous antifungal therapies for patients with invasive aspergillosis in the United States. Mycoses. 54: pp. e301-12 CrossRef
  49. Vandewoude, KH, Blot, SI, Benoit, D, Colardyn, F, Vogelaers, D (2004) Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence. J Hosp Infect. 56: pp. 269-76 CrossRef
  50. Robinett, KS, Weiler, B, Verceles, AC (2013) Invasive aspergillosis masquerading as catastrophic antiphospholipid syndrome. Am J Crit Care. 22: pp. 448-51 CrossRef
  51. Winters, B, Custer, J, Galvagno, SM, Colantuoni, E, Kapoor, SG, Lee, H (2012) Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf. 21: pp. 894-902 CrossRef
  52. Mullins, J, Harvey, R, Seaton, A (1976) Sources and incidence of airborne Aspergillus fumigatus (Fres). Clin Allergy. 6: pp. 209-17 CrossRef
  53. Pel谩ez, T, Mu帽oz, P, Guinea, J, Valerio, M, Giannella, M, Klaassen, CHW (2012) Outbreak of invasive aspergillosis after major heart surgery caused by spores in the air of the intensive care unit. Clin Infect Dis. 54: pp. e24-31 CrossRef
  
• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction 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鈥?鈥?.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.