Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes
Identifieur interne : 000B44 ( Pmc/Curation ); précédent : 000B43; suivant : 000B45Epidemiology 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.
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
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DOI: 10.1186/s13054-014-0722-7
PubMed: 25928694
PubMed Central: 4344741
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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></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></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></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></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></affiliation></author><author><name sortKey="Vogelaers, Dirk" sort="Vogelaers, Dirk" uniqKey="Vogelaers D" first="Dirk" last="Vogelaers">Dirk Vogelaers</name><affiliation wicri:level="1"><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></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="1"><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></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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25928694</idno><idno type="pmc">4344741</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344741</idno><idno type="RBID">PMC:4344741</idno><idno type="doi">10.1186/s13054-014-0722-7</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000B67</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B67</idno><idno type="wicri:Area/Pmc/Curation">000B44</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000B44</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes</title><author><name sortKey="Taccone, Fabio Silvio" sort="Taccone, Fabio Silvio" uniqKey="Taccone F" first="Fabio Silvio" last="Taccone">Fabio Silvio Taccone</name><affiliation wicri:level="1"><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></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="1"><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></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></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></affiliation></author><author><name sortKey="Meersseman, Wouter" sort="Meersseman, Wouter" uniqKey="Meersseman W" first="Wouter" last="Meersseman">Wouter Meersseman</name><affiliation wicri:level="1"><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></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></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></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></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></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></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></affiliation></author><author><name sortKey="Vogelaers, Dirk" sort="Vogelaers, Dirk" uniqKey="Vogelaers D" first="Dirk" last="Vogelaers">Dirk Vogelaers</name><affiliation wicri:level="1"><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></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="1"><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></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></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></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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<front><journal-meta><journal-id journal-id-type="nlm-ta">Crit Care</journal-id><journal-title-group><journal-title>Critical Care</journal-title></journal-title-group><issn pub-type="ppub">1364-8535</issn><issn pub-type="epub">1466-609X</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25928694</article-id><article-id pub-id-type="pmc">4344741</article-id><article-id pub-id-type="publisher-id">722</article-id><article-id pub-id-type="doi">10.1186/s13054-014-0722-7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Taccone</surname><given-names>Fabio Silvio</given-names></name><address><email>ftaccone@ulb.ac.be</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Van den Abeele</surname><given-names>Anne-Marie</given-names></name><address><email>anne-marie.vandenabeele@azstlucas.be</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Bulpa</surname><given-names>Pierre</given-names></name><address><email>pierre.bulpa@aclouvain.be</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Misset</surname><given-names>Benoit</given-names></name><address><email>bmisset@hpsj.fr</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Meersseman</surname><given-names>Wouter</given-names></name><address><email>wouter.meersseman@uzleuven.be</email></address><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Cardoso</surname><given-names>Teresa</given-names></name><address><email>cardoso.tmc@gmail.com</email></address><xref ref-type="aff" rid="Aff6"></xref></contrib><contrib contrib-type="author"><name><surname>Paiva</surname><given-names>José-Artur</given-names></name><address><email>jarturpaiva@gmail.com</email></address><xref ref-type="aff" rid="Aff7"></xref></contrib><contrib contrib-type="author"><name><surname>Blasco-Navalpotro</surname><given-names>Miguel</given-names></name><address><email>mblasco.hsvo@salud.madrid.org</email></address><xref ref-type="aff" rid="Aff8"></xref></contrib><contrib contrib-type="author"><name><surname>De Laere</surname><given-names>Emmanuel</given-names></name><address><email>emmanuel.delaere@azdelta.be</email></address><xref ref-type="aff" rid="Aff9"></xref></contrib><contrib contrib-type="author"><name><surname>Dimopoulos</surname><given-names>George</given-names></name><address><email>gdimop@med.uoa.gr</email></address><xref ref-type="aff" rid="Aff10"></xref></contrib><contrib contrib-type="author"><name><surname>Rello</surname><given-names>Jordi</given-names></name><address><email>jrello@crips.es</email></address><xref ref-type="aff" rid="Aff11"></xref></contrib><contrib contrib-type="author"><name><surname>Vogelaers</surname><given-names>Dirk</given-names></name><address><email>dirk.vogelaers@uzgent.be</email></address><xref ref-type="aff" rid="Aff12"></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Blot</surname><given-names>Stijn I</given-names></name><address><email>stijn.blot@ugent.be</email></address><xref ref-type="aff" rid="Aff12"></xref><xref ref-type="aff" rid="Aff13"></xref></contrib><contrib contrib-type="author"><collab>on behalf of the AspICU Study Investigators</collab></contrib><aff id="Aff1"><label></label>Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070 Brussels, Belgium</aff><aff id="Aff2"><label></label>Department of Microbiology General Hospital St. Lucas, Groenebriel 1, 9000 Ghent, Belgium</aff><aff id="Aff3"><label></label>Department of Intensive Care Mont-Godinne University Hospital, Catholic University of Louvain, Avenue G.Thérasse 1, 5530 Yvoir, Belgium</aff><aff id="Aff4"><label></label>Department of Intensive Care Foundation Hospital Saint-Joseph, Paris-Descartes University, 185 Rue Raymond Losserand, 75014 Paris, France</aff><aff id="Aff5"><label></label>Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium</aff><aff id="Aff6"><label></label>Department of Intensive Care, Santo Antonio Hospital, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal</aff><aff id="Aff7"><label></label>Department of Emergency and Intensive Care, Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal</aff><aff id="Aff8"><label></label>Department of Intensive Care, University Hospital Severo Ochoa, Avenida de Orellana, s/n 28911 Leganés Madrid, Spain</aff><aff id="Aff9"><label></label>Department of Microbiology, General Hospital Delta, Brugsesteenweg 90, 8800 Roeselare, Belgium</aff><aff id="Aff10"><label></label>Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Haidari, 124 62 Athens, Greece</aff><aff id="Aff11"><label></label>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</aff><aff id="Aff12"><label></label>Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium</aff><aff id="Aff13"><label></label>Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Butterfield Street, Herston (Brisbane), 4006 Queensland, Australia</aff></contrib-group><pub-date pub-type="epub"><day>12</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>12</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="ppub"><year>2015</year></pub-date><volume>19</volume><issue>1</issue><elocation-id>7</elocation-id><history><date date-type="received"><day>11</day><month>7</month><year>2014</year></date><date date-type="accepted"><day>15</day><month>12</month><year>2014</year></date></history><permissions><copyright-statement>© Taccone et al.; licensee BioMed Central. 2015</copyright-statement><license license-type="open-access"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0">http://creativecommons.org/licenses/by/4.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><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. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with <italic>Aspergillus</italic> spp colonization.</p></sec></abstract><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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