Aspergillus in the lower respiratory tract of immunocompetent critically ill patients.

Autor: Lugosi M; 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., Alberti C; Epidemiologic Clinical Unit, INSERM, Robert Debre Hospital and Paris 7 Denis Diderot University, Paris, France., Zahar JR; Bacteriological-Virological Unit, Necker Hospital and Paris 5 René Descartes University, Paris, France., Garrouste M; 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., Lemiale V; 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., Descorps-Desclère A; Surgical Intensive Care Unit, Antoine Béclère Hospital, Clamart, France., Ricard JD; Intensive Care Unit, Louis Mourier Hospital, Colombes, France., Goldgran-Tolédano D; Intensive Care Unit, Gonesse Hospital, Gonesse, France., Cohen Y; Surgical Intensive Care Unit, Avicenne Hospital and Paris 13 University, Bobigny, France., Schwebel C; Grenoble 1 University, Medical Intensive Care Unit, Albert Michallon University Hospital, Grenoble, France., Vésin A; Grenoble 1 University, Albert Bonniot Institute, Team 11: Outcome of Airway Cancers and Mechanically Ventilated Patients, Grenoble, France; Biostatistical Department, Outcomerea Organisation, Paris, France., Timsit JF; 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., Azoulay E; 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.
Jazyk: angličtina
Zdroj: The Journal of infection [J Infect] 2014 Sep; Vol. 69 (3), pp. 284-92. Date of Electronic Publication: 2014 Jun 09.
DOI: 10.1016/j.jinf.2014.04.010
Abstrakt: Objectives: 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.
(Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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