Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes
Identifieur interne : 002E47 ( Main/Exploration ); précédent : 002E46; suivant : 002E48Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes
Auteurs : Fabio Silvio Taccone [Belgique] ; Anne-Marie Van Den Abeele [Belgique] ; Pierre Bulpa [Belgique] ; Benoit Misset [France] ; Wouter Meersseman [Belgique] ; Teresa Cardoso [Portugal] ; José-Artur Paiva [Portugal] ; Miguel Blasco-Navalpotro [Espagne] ; Emmanuel De Laere [Belgique] ; George Dimopoulos [Grèce] ; Jordi Rello [Espagne] ; Dirk Vogelaers [Belgique] ; Stijn I. Blot [Belgique, Australie]Source :
- Critical Care [ 1364-8535 ] ; 2015.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Aspergillose pulmonaire (), Aspergillose pulmonaire (diagnostic), Aspergillose pulmonaire (mortalité), Comorbidité, Facteurs de risque, Femelle, Humains, Incidence, Infections opportunistes (diagnostic), Infections opportunistes (mortalité), Maladie grave, Mâle, Sujet immunodéprimé, Sujet âgé, Unités de soins intensifs, Ventilation artificielle (effets indésirables).
- MESH :
- diagnostic : Aspergillose pulmonaire, Infections opportunistes.
- effets indésirables : Ventilation artificielle.
- mortalité : Aspergillose pulmonaire, Infections opportunistes.
- Adulte, Adulte d'âge moyen, Aspergillose pulmonaire, Comorbidité, Facteurs de risque, Femelle, Humains, Incidence, Maladie grave, Mâle, Sujet immunodéprimé, Sujet âgé, Unités de soins intensifs.
English descriptors
- KwdEn :
- Adult, Aged, Comorbidity, Critical Illness, Female, Humans, Immunocompromised Host, Incidence, Intensive Care Units, Male, Middle Aged, Opportunistic Infections (diagnosis), Opportunistic Infections (mortality), Pulmonary Aspergillosis (complications), Pulmonary Aspergillosis (diagnosis), Pulmonary Aspergillosis (mortality), Respiration, Artificial (adverse effects), Risk Factors.
- MESH :
- adverse effects : Respiration, Artificial.
- complications : Pulmonary Aspergillosis.
- diagnosis : Opportunistic Infections, Pulmonary Aspergillosis.
- mortality : Opportunistic Infections, Pulmonary Aspergillosis.
- Adult, Aged, Comorbidity, Critical Illness, Female, Humans, Immunocompromised Host, Incidence, Intensive Care Units, Male, Middle Aged, Risk Factors.
Abstract
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.
An observational study including all patients with a positive
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
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
Url:
DOI: 10.1186/s13054-014-0722-7
PubMed: 25928694
PubMed Central: 4344741
Affiliations:
- Australie, Belgique, Espagne, France, Grèce, Portugal
- Catalogne, Province de Flandre-Orientale, Province du Brabant flamand, Vienne (Autriche), Île-de-France
- Barcelone, Gand, Louvain, Paris, Vienne (Autriche)
- Université de Gand
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Le document en format XML
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sortKey="Taccone, Fabio Silvio" sort="Taccone, Fabio Silvio" uniqKey="Taccone F" first="Fabio Silvio" last="Taccone">Fabio Silvio Taccone</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 Brussels</wicri:regionArea><placeName><region type="land" nuts="2">Vienne (Autriche)</region><settlement type="city">Vienne (Autriche)</settlement></placeName></affiliation></author><author><name sortKey="Van Den Abeele, Anne Marie" sort="Van Den Abeele, Anne Marie" uniqKey="Van Den Abeele A" first="Anne-Marie" last="Van Den Abeele">Anne-Marie Van Den Abeele</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Microbiology General Hospital St. Lucas, Groenebriel 1, 9000 Ghent, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Microbiology General Hospital St. Lucas, Groenebriel 1, 9000 Ghent</wicri:regionArea><placeName><region type="province" nuts="2">Province de Flandre-Orientale</region><settlement type="city">Gand</settlement></placeName></affiliation></author><author><name sortKey="Bulpa, Pierre" sort="Bulpa, Pierre" uniqKey="Bulpa P" first="Pierre" last="Bulpa">Pierre Bulpa</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Department of Intensive Care Mont-Godinne University Hospital, Catholic University of Louvain, Avenue G.Thérasse 1, 5530 Yvoir, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Intensive Care Mont-Godinne University Hospital, Catholic University of Louvain, Avenue G.Thérasse 1, 5530 Yvoir</wicri:regionArea><wicri:noRegion>5530 Yvoir</wicri:noRegion></affiliation></author><author><name sortKey="Misset, Benoit" sort="Misset, Benoit" uniqKey="Misset B" first="Benoit" last="Misset">Benoit Misset</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Department of Intensive Care Foundation Hospital Saint-Joseph, Paris-Descartes University, 185 Rue Raymond Losserand, 75014 Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Department of Intensive Care Foundation Hospital Saint-Joseph, Paris-Descartes University, 185 Rue Raymond Losserand, 75014 Paris</wicri:regionArea><wicri:noRegion>75014 Paris</wicri:noRegion><placeName><settlement type="city">Paris</settlement><region type="région" nuts="2">Île-de-France</region></placeName></affiliation></author><author><name sortKey="Meersseman, Wouter" sort="Meersseman, Wouter" uniqKey="Meersseman W" first="Wouter" last="Meersseman">Wouter Meersseman</name><affiliation wicri:level="3"><nlm:aff id="Aff5">Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, 3000 Leuven</wicri:regionArea><placeName><region type="province" nuts="2">Province du Brabant flamand</region><settlement type="city">Louvain</settlement></placeName></affiliation></author><author><name sortKey="Cardoso, Teresa" sort="Cardoso, Teresa" uniqKey="Cardoso T" first="Teresa" last="Cardoso">Teresa Cardoso</name><affiliation wicri:level="1"><nlm:aff id="Aff6">Department of Intensive Care, Santo Antonio Hospital, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal</nlm:aff><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Intensive Care, Santo Antonio Hospital, Largo Prof. Abel Salazar, 4099-001 Porto</wicri:regionArea><wicri:noRegion>4099-001 Porto</wicri:noRegion></affiliation></author><author><name sortKey="Paiva, Jose Artur" sort="Paiva, Jose Artur" uniqKey="Paiva J" first="José-Artur" last="Paiva">José-Artur Paiva</name><affiliation wicri:level="1"><nlm:aff id="Aff7">Department of Emergency and Intensive Care, Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal</nlm:aff><country xml:lang="fr">Portugal</country><wicri:regionArea>Department of Emergency and Intensive Care, Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hernâni Monteiro, 4200-319 Porto</wicri:regionArea><wicri:noRegion>4200-319 Porto</wicri:noRegion></affiliation></author><author><name sortKey="Blasco Navalpotro, Miguel" sort="Blasco Navalpotro, Miguel" uniqKey="Blasco Navalpotro M" first="Miguel" last="Blasco-Navalpotro">Miguel Blasco-Navalpotro</name><affiliation wicri:level="1"><nlm:aff id="Aff8">Department of Intensive Care, University Hospital Severo Ochoa, Avenida de Orellana, s/n 28911 Leganés Madrid, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Intensive Care, University Hospital Severo Ochoa, Avenida de Orellana, s/n 28911 Leganés Madrid</wicri:regionArea><wicri:noRegion>s/n 28911 Leganés Madrid</wicri:noRegion></affiliation></author><author><name sortKey="De Laere, Emmanuel" sort="De Laere, Emmanuel" uniqKey="De Laere E" first="Emmanuel" last="De Laere">Emmanuel De Laere</name><affiliation wicri:level="1"><nlm:aff id="Aff9">Department of Microbiology, General Hospital Delta, Brugsesteenweg 90, 8800 Roeselare, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Microbiology, General Hospital Delta, Brugsesteenweg 90, 8800 Roeselare</wicri:regionArea><wicri:noRegion>8800 Roeselare</wicri:noRegion></affiliation></author><author><name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Haidari, 124 62 Athens, Greece</nlm:aff><country xml:lang="fr">Grèce</country><wicri:regionArea>Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Haidari, 124 62 Athens</wicri:regionArea><wicri:noRegion>124 62 Athens</wicri:noRegion></affiliation></author><author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name><affiliation wicri:level="1"><nlm:aff id="Aff11">Hospital Universitari Vall d’Hebron, Vall D’Hebron, Institute of Research, CIBERES, Autonomous University of Barcelona, Passeig Vall d’Hebron, 119-129, 08035 Barcelona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Hospital Universitari Vall d’Hebron, Vall D’Hebron, Institute of Research, CIBERES, Autonomous University of Barcelona, Passeig Vall d’Hebron, 119-129, 08035 Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Vogelaers, Dirk" sort="Vogelaers, Dirk" uniqKey="Vogelaers D" first="Dirk" last="Vogelaers">Dirk Vogelaers</name><affiliation wicri:level="4"><nlm:aff id="Aff12">Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000 Ghent</wicri:regionArea><placeName><region type="province" nuts="2">Province de Flandre-Orientale</region><settlement type="city">Gand</settlement><settlement type="city">Gand</settlement></placeName><orgName type="university">Université de Gand</orgName></affiliation></author><author><name sortKey="Blot, Stijn I" sort="Blot, Stijn I" uniqKey="Blot S" first="Stijn I" last="Blot">Stijn I. Blot</name><affiliation wicri:level="4"><nlm:aff id="Aff12">Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium</nlm:aff><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000 Ghent</wicri:regionArea><placeName><region type="province" nuts="2">Province de Flandre-Orientale</region><settlement type="city">Gand</settlement><settlement type="city">Gand</settlement></placeName><orgName type="university">Université de Gand</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff13">Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Butterfield Street, Herston (Brisbane), 4006 Queensland, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Butterfield Street, Herston (Brisbane), 4006 Queensland</wicri:regionArea><wicri:noRegion>4006 Queensland</wicri:noRegion></affiliation></author></analytic><series><title level="j">Critical Care</title><idno type="ISSN">1364-8535</idno><idno type="eISSN">1466-609X</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Comorbidity</term><term>Critical Illness</term><term>Female</term><term>Humans</term><term>Immunocompromised Host</term><term>Incidence</term><term>Intensive Care Units</term><term>Male</term><term>Middle Aged</term><term>Opportunistic Infections (diagnosis)</term><term>Opportunistic Infections (mortality)</term><term>Pulmonary Aspergillosis (complications)</term><term>Pulmonary Aspergillosis (diagnosis)</term><term>Pulmonary Aspergillosis (mortality)</term><term>Respiration, Artificial (adverse effects)</term><term>Risk Factors</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aspergillose pulmonaire ()</term><term>Aspergillose pulmonaire (diagnostic)</term><term>Aspergillose pulmonaire (mortalité)</term><term>Comorbidité</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Infections opportunistes (diagnostic)</term><term>Infections opportunistes (mortalité)</term><term>Maladie grave</term><term>Mâle</term><term>Sujet immunodéprimé</term><term>Sujet âgé</term><term>Unités de soins intensifs</term><term>Ventilation artificielle (effets indésirables)</term></keywords><keywords scheme="MESH" qualifier="adverse effects" xml:lang="en"><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Pulmonary Aspergillosis</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Opportunistic Infections</term><term>Pulmonary Aspergillosis</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Aspergillose pulmonaire</term><term>Infections opportunistes</term></keywords><keywords scheme="MESH" qualifier="effets indésirables" xml:lang="fr"><term>Ventilation artificielle</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Opportunistic Infections</term><term>Pulmonary Aspergillosis</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Aspergillose pulmonaire</term><term>Infections opportunistes</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Comorbidity</term><term>Critical Illness</term><term>Female</term><term>Humans</term><term>Immunocompromised Host</term><term>Incidence</term><term>Intensive Care Units</term><term>Male</term><term>Middle Aged</term><term>Risk Factors</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Aspergillose pulmonaire</term><term>Comorbidité</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Incidence</term><term>Maladie grave</term><term>Mâle</term><term>Sujet immunodéprimé</term><term>Sujet âgé</term><term>Unités de soins intensifs</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>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.</p></sec><sec><title>Methods</title><p>An observational study including all patients with a positive <italic>Aspergillus</italic> culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or <italic>Aspergillus</italic> colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after <italic>Aspergillus</italic> isolation.</p></sec><sec><title>Results</title><p>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 <italic>Aspergillus fumigatus</italic> 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 (<italic>P</italic> < 0.001). 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.</p></sec><sec><title>Conclusions</title><p>IA among critically ill patients is associated with high mortality. 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sortKey="Harvey, R" uniqKey="Harvey R">R Harvey</name></author><author><name sortKey="Seaton, A" uniqKey="Seaton A">A Seaton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pelaez, T" uniqKey="Pelaez T">T Peláez</name></author><author><name sortKey="Mu Oz, P" uniqKey="Mu Oz P">P Muñoz</name></author><author><name sortKey="Guinea, J" uniqKey="Guinea J">J Guinea</name></author><author><name sortKey="Valerio, M" uniqKey="Valerio M">M Valerio</name></author><author><name sortKey="Giannella, M" uniqKey="Giannella M">M Giannella</name></author><author><name sortKey="Klaassen, Chw" uniqKey="Klaassen C">CHW Klaassen</name></author></analytic></biblStruct></listBibl></div1></back></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>Catalogne</li><li>Province de Flandre-Orientale</li><li>Province du Brabant flamand</li><li>Vienne (Autriche)</li><li>Île-de-France</li></region><settlement><li>Barcelone</li><li>Gand</li><li>Louvain</li><li>Paris</li><li>Vienne (Autriche)</li></settlement><orgName><li>Université de Gand</li></orgName></list><tree><country name="Belgique"><region name="Vienne (Autriche)"><name sortKey="Taccone, Fabio Silvio" sort="Taccone, Fabio Silvio" uniqKey="Taccone F" first="Fabio Silvio" last="Taccone">Fabio Silvio Taccone</name></region><name sortKey="Blot, Stijn I" sort="Blot, Stijn I" uniqKey="Blot S" first="Stijn I" last="Blot">Stijn I. Blot</name><name sortKey="Bulpa, Pierre" sort="Bulpa, Pierre" uniqKey="Bulpa P" first="Pierre" last="Bulpa">Pierre Bulpa</name><name sortKey="De Laere, Emmanuel" sort="De Laere, Emmanuel" uniqKey="De Laere E" first="Emmanuel" last="De Laere">Emmanuel De Laere</name><name sortKey="Meersseman, Wouter" sort="Meersseman, Wouter" uniqKey="Meersseman W" first="Wouter" last="Meersseman">Wouter Meersseman</name><name sortKey="Van Den Abeele, Anne Marie" sort="Van Den Abeele, Anne Marie" uniqKey="Van Den Abeele A" first="Anne-Marie" last="Van Den Abeele">Anne-Marie Van Den Abeele</name><name sortKey="Vogelaers, Dirk" sort="Vogelaers, Dirk" uniqKey="Vogelaers D" first="Dirk" last="Vogelaers">Dirk Vogelaers</name></country><country name="France"><region name="Île-de-France"><name sortKey="Misset, Benoit" sort="Misset, Benoit" uniqKey="Misset B" first="Benoit" last="Misset">Benoit Misset</name></region></country><country name="Portugal"><noRegion><name sortKey="Cardoso, Teresa" sort="Cardoso, Teresa" uniqKey="Cardoso T" first="Teresa" last="Cardoso">Teresa Cardoso</name></noRegion><name sortKey="Paiva, Jose Artur" sort="Paiva, Jose Artur" uniqKey="Paiva J" first="José-Artur" last="Paiva">José-Artur Paiva</name></country><country name="Espagne"><noRegion><name sortKey="Blasco Navalpotro, Miguel" sort="Blasco Navalpotro, Miguel" uniqKey="Blasco Navalpotro M" first="Miguel" last="Blasco-Navalpotro">Miguel Blasco-Navalpotro</name></noRegion><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name></country><country name="Grèce"><noRegion><name sortKey="Dimopoulos, George" sort="Dimopoulos, George" uniqKey="Dimopoulos G" first="George" last="Dimopoulos">George Dimopoulos</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Blot, Stijn I" sort="Blot, Stijn I" uniqKey="Blot S" first="Stijn I" last="Blot">Stijn I. 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