Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures.
Identifieur interne : 000D94 ( Main/Exploration ); précédent : 000D93; suivant : 000D95Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures.
Auteurs : J A Paiva [Portugal] ; P. Mergulhão [Portugal] ; A. Gomes [Portugal] ; F S Taccone [Belgique] ; A-M Van Den Abeele [Belgique] ; P. Bulpa [Belgique] ; B. Misset [France] ; W. Meersseman [Belgique] ; G. Dimopoulos [Grèce] ; J. Rello [Espagne] ; D. Vogelaers [Belgique] ; S. Blot [Australie]Source :
- International journal of antimicrobial agents [ 1872-7913 ] ; 2017.
Abstract
Invasive pulmonary aspergillosis (IPA) is an increasingly recognised problem in critically ill patients. Little is known about how intensivists react to an Aspergillus-positive respiratory sample or the efficacy of antifungal therapy (AFT). This study aimed to identify drivers of AFT prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. ICU patients with an Aspergillus-positive respiratory sample from the database of a previous observational, multicentre study were analysed. Cases were classified as proven/putative IPA or Aspergillus colonisation. Demographic, microbiological, diagnostic and therapeutic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Patients with putative/proven IPA were more likely to receive AFT than colonised patients (78.7% vs. 25.5%; P <0.001). Patients with host factors for invasive fungal disease were more likely to receive AFT (72.5% vs. 37.4%) as were those with multiorgan failure (SOFA score >7) (68.4% vs. 36.9%) (both P <0.001). Once adjusted for disease severity, initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI 0.89-2.21). Likewise, treatment within 48 h following diagnosis did not change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. IPA in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multiorgan failure.
DOI: 10.1016/j.ijantimicag.2017.05.017
PubMed: 28669830
Affiliations:
- Australie, Belgique, Espagne, France, Grèce, Portugal
- Attique (région), Catalogne, Province de Flandre-Orientale, Région de Bruxelles-Capitale, Région flamande, Île-de-France
- Athènes, Barcelone, Bruxelles, Gand, Paris
- Université Paris-Descartes, Université de Gand, Université libre de Bruxelles
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Joao and University of Porto Faculty of Medicine, Grupo de Infecção e Sépsis, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Emergency and Intensive Care, Centro Hospitalar S. Joao and University of Porto Faculty of Medicine, Grupo de Infecção e Sépsis, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Mergulhao, P" sort="Mergulhao, P" uniqKey="Mergulhao P" first="P" last="Mergulhão">P. Mergulhão</name><affiliation wicri:level="1"><nlm:affiliation>Department of Emergency and Intensive Care, Centro Hospitalar S. Joao and University of Porto Faculty of Medicine, Grupo de Infecção e Sépsis, Porto, Portugal. Electronic address: pjmergulhao@gmail.com.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Emergency and Intensive Care, Centro Hospitalar S. Joao and University of Porto Faculty of Medicine, Grupo de Infecção e Sépsis, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Gomes, A" sort="Gomes, A" uniqKey="Gomes A" first="A" last="Gomes">A. Gomes</name><affiliation wicri:level="1"><nlm:affiliation>Department of Emergency and Intensive Care, Centro Hospitalar S. Joao and University of Porto Faculty of Medicine, Grupo de Infecção e Sépsis, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Emergency and Intensive Care, Centro Hospitalar S. Joao and University of Porto Faculty of Medicine, Grupo de Infecção e Sépsis, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Taccone, F S" sort="Taccone, F S" uniqKey="Taccone F" first="F S" last="Taccone">F S Taccone</name><affiliation wicri:level="4"><nlm:affiliation>Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels</wicri:regionArea><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region><settlement type="city">Bruxelles</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author><author><name sortKey="Van Den Abeele, A M" sort="Van Den Abeele, A M" uniqKey="Van Den Abeele A" first="A-M" last="Van Den Abeele">A-M Van Den Abeele</name><affiliation wicri:level="1"><nlm:affiliation>Department of Microbiology, General Hospital St Lucas, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Microbiology, General Hospital St Lucas, Ghent</wicri:regionArea><wicri:noRegion>Ghent</wicri:noRegion></affiliation></author><author><name sortKey="Bulpa, P" sort="Bulpa, P" uniqKey="Bulpa P" first="P" last="Bulpa">P. Bulpa</name><affiliation wicri:level="1"><nlm:affiliation>Department of Intensive Care, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir</wicri:regionArea><wicri:noRegion>Yvoir</wicri:noRegion></affiliation></author><author><name sortKey="Misset, B" sort="Misset, B" uniqKey="Misset B" first="B" last="Misset">B. 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Meersseman</name><affiliation wicri:level="1"><nlm:affiliation>Medical Intensive Care Unit, University Hospital Leuven, Leuven, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Medical Intensive Care Unit, University Hospital Leuven, Leuven</wicri:regionArea><wicri:noRegion>Leuven</wicri:noRegion></affiliation></author><author><name sortKey="Dimopoulos, G" sort="Dimopoulos, G" uniqKey="Dimopoulos G" first="G" last="Dimopoulos">G. Dimopoulos</name><affiliation wicri:level="3"><nlm:affiliation>Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece.</nlm:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name><affiliation wicri:level="3"><nlm:affiliation>Hospital Universitari Vall d'Hebron, Vall d'Hebron, Institute of Research, CIBERES, Universitat Autònoma de Barcelona, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Universitari Vall d'Hebron, Vall d'Hebron, Institute of Research, CIBERES, Universitat Autònoma de Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Vogelaers, D" sort="Vogelaers, D" uniqKey="Vogelaers D" first="D" last="Vogelaers">D. Vogelaers</name><affiliation wicri:level="4"><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name><affiliation wicri:level="4"><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium; Burns, Trauma & Critical Care Research Centre, The University of Queensland, Brisbane, QLD</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author></analytic><series><title level="j">International journal of antimicrobial agents</title><idno type="eISSN">1872-7913</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Invasive pulmonary aspergillosis (IPA) is an increasingly recognised problem in critically ill patients. Little is known about how intensivists react to an Aspergillus-positive respiratory sample or the efficacy of antifungal therapy (AFT). This study aimed to identify drivers of AFT prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. ICU patients with an Aspergillus-positive respiratory sample from the database of a previous observational, multicentre study were analysed. Cases were classified as proven/putative IPA or Aspergillus colonisation. Demographic, microbiological, diagnostic and therapeutic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Patients with putative/proven IPA were more likely to receive AFT than colonised patients (78.7% vs. 25.5%; P <0.001). Patients with host factors for invasive fungal disease were more likely to receive AFT (72.5% vs. 37.4%) as were those with multiorgan failure (SOFA score >7) (68.4% vs. 36.9%) (both P <0.001). Once adjusted for disease severity, initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI 0.89-2.21). Likewise, treatment within 48 h following diagnosis did not change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. IPA in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multiorgan failure.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Grèce</li><li>Portugal</li></country><region><li>Attique (région)</li><li>Catalogne</li><li>Province de Flandre-Orientale</li><li>Région de Bruxelles-Capitale</li><li>Région flamande</li><li>Île-de-France</li></region><settlement><li>Athènes</li><li>Barcelone</li><li>Bruxelles</li><li>Gand</li><li>Paris</li></settlement><orgName><li>Université Paris-Descartes</li><li>Université de Gand</li><li>Université libre de Bruxelles</li></orgName></list><tree><country name="Portugal"><noRegion><name sortKey="Paiva, J A" sort="Paiva, J A" uniqKey="Paiva J" first="J A" last="Paiva">J A Paiva</name></noRegion><name sortKey="Gomes, A" sort="Gomes, A" uniqKey="Gomes A" first="A" last="Gomes">A. Gomes</name><name sortKey="Mergulhao, P" sort="Mergulhao, P" uniqKey="Mergulhao P" first="P" last="Mergulhão">P. Mergulhão</name></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Taccone, F S" sort="Taccone, F S" uniqKey="Taccone F" first="F S" last="Taccone">F S Taccone</name></region><name sortKey="Bulpa, P" sort="Bulpa, P" uniqKey="Bulpa P" first="P" last="Bulpa">P. Bulpa</name><name sortKey="Meersseman, W" sort="Meersseman, W" uniqKey="Meersseman W" first="W" last="Meersseman">W. Meersseman</name><name sortKey="Van Den Abeele, A M" sort="Van Den Abeele, A M" uniqKey="Van Den Abeele A" first="A-M" last="Van Den Abeele">A-M Van Den Abeele</name><name sortKey="Vogelaers, D" sort="Vogelaers, D" uniqKey="Vogelaers D" first="D" last="Vogelaers">D. Vogelaers</name></country><country name="France"><region name="Île-de-France"><name sortKey="Misset, B" sort="Misset, B" uniqKey="Misset B" first="B" last="Misset">B. Misset</name></region></country><country name="Grèce"><region name="Attique (région)"><name sortKey="Dimopoulos, G" sort="Dimopoulos, G" uniqKey="Dimopoulos G" first="G" last="Dimopoulos">G. Dimopoulos</name></region></country><country name="Espagne"><region name="Catalogne"><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name></region></country><country name="Australie"><region name="Région flamande"><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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