Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study.
Identifieur interne : 000009 ( Main/Corpus ); précédent : 000008; suivant : 000010Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study.
Auteurs : Alexander F A D. Schauwvlieghe ; Bart J A. Rijnders ; Nele Philips ; Rosanne Verwijs ; Lore Vanderbeke ; Carla Van Tienen ; Katrien Lagrou ; Paul E. Verweij ; Frank L. Van De Veerdonk ; Diederik Gommers ; Peter Spronk ; Dennis C J J. Bergmans ; Astrid Hoedemaekers ; Eleni-Rosalina Andrinopoulou ; Charlotte H S B. Van Den Berg ; Nicole P. Juffermans ; Casper J. Hodiamont ; Alieke G. Vonk ; Pieter Depuydt ; Jerina Boelens ; Joost WautersSource :
- The Lancet. Respiratory medicine [ 2213-2619 ] ; 2018.
English descriptors
- KwdEn :
- APACHE, Aged, Aspergillus, Belgium (epidemiology), Female, Humans, Incidence, Influenza A virus, Influenza B virus, Influenza, Human (epidemiology), Influenza, Human (microbiology), Intensive Care Units (statistics & numerical data), Invasive Pulmonary Aspergillosis (epidemiology), Invasive Pulmonary Aspergillosis (microbiology), Male, Middle Aged, Netherlands (epidemiology), Odds Ratio, Patient Admission (statistics & numerical data), Retrospective Studies.
- MESH :
- geographic , epidemiology : Belgium, Netherlands.
- epidemiology : Influenza, Human, Invasive Pulmonary Aspergillosis.
- microbiology : Influenza, Human, Invasive Pulmonary Aspergillosis.
- statistics & numerical data : Intensive Care Units, Patient Admission.
- APACHE, Aged, Aspergillus, Female, Humans, Incidence, Influenza A virus, Influenza B virus, Male, Middle Aged, Odds Ratio, Retrospective Studies.
Abstract
BACKGROUND
Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.
METHODS
We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no 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] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).
FINDINGS
Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.
INTERPRETATION
Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.
FUNDING
None.
DOI: 10.1016/S2213-2600(18)30274-1
PubMed: 30076119
Links to Exploration step
pubmed:30076119Le document en format XML
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<affiliation><nlm:affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
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<author><name sortKey="Rijnders, Bart J A" sort="Rijnders, Bart J A" uniqKey="Rijnders B" first="Bart J A" last="Rijnders">Bart J A. Rijnders</name>
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<author><name sortKey="Philips, Nele" sort="Philips, Nele" uniqKey="Philips N" first="Nele" last="Philips">Nele Philips</name>
<affiliation><nlm:affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Verwijs, Rosanne" sort="Verwijs, Rosanne" uniqKey="Verwijs R" first="Rosanne" last="Verwijs">Rosanne Verwijs</name>
<affiliation><nlm:affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vanderbeke, Lore" sort="Vanderbeke, Lore" uniqKey="Vanderbeke L" first="Lore" last="Vanderbeke">Lore Vanderbeke</name>
<affiliation><nlm:affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Tienen, Carla" sort="Van Tienen, Carla" uniqKey="Van Tienen C" first="Carla" last="Van Tienen">Carla Van Tienen</name>
<affiliation><nlm:affiliation>Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Lagrou, Katrien" sort="Lagrou, Katrien" uniqKey="Lagrou K" first="Katrien" last="Lagrou">Katrien Lagrou</name>
<affiliation><nlm:affiliation>Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Verweij, Paul E" sort="Verweij, Paul E" uniqKey="Verweij P" first="Paul E" last="Verweij">Paul E. Verweij</name>
<affiliation><nlm:affiliation>Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Centre of Expertise in Mycology, Radboudumc/CWZ, Nijmegen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van De Veerdonk, Frank L" sort="Van De Veerdonk, Frank L" uniqKey="Van De Veerdonk F" first="Frank L" last="Van De Veerdonk">Frank L. Van De Veerdonk</name>
<affiliation><nlm:affiliation>Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Gommers, Diederik" sort="Gommers, Diederik" uniqKey="Gommers D" first="Diederik" last="Gommers">Diederik Gommers</name>
<affiliation><nlm:affiliation>Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Spronk, Peter" sort="Spronk, Peter" uniqKey="Spronk P" first="Peter" last="Spronk">Peter Spronk</name>
<affiliation><nlm:affiliation>Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Bergmans, Dennis C J J" sort="Bergmans, Dennis C J J" uniqKey="Bergmans D" first="Dennis C J J" last="Bergmans">Dennis C J J. Bergmans</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Maastricht University Medical Centre, Maastricht, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Hoedemaekers, Astrid" sort="Hoedemaekers, Astrid" uniqKey="Hoedemaekers A" first="Astrid" last="Hoedemaekers">Astrid Hoedemaekers</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Andrinopoulou, Eleni Rosalina" sort="Andrinopoulou, Eleni Rosalina" uniqKey="Andrinopoulou E" first="Eleni-Rosalina" last="Andrinopoulou">Eleni-Rosalina Andrinopoulou</name>
<affiliation><nlm:affiliation>Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Den Berg, Charlotte H S B" sort="Van Den Berg, Charlotte H S B" uniqKey="Van Den Berg C" first="Charlotte H S B" last="Van Den Berg">Charlotte H S B. Van Den Berg</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands; Department of Intensive Care, University Medical Center Groningen, Groningen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Juffermans, Nicole P" sort="Juffermans, Nicole P" uniqKey="Juffermans N" first="Nicole P" last="Juffermans">Nicole P. Juffermans</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Hodiamont, Casper J" sort="Hodiamont, Casper J" uniqKey="Hodiamont C" first="Casper J" last="Hodiamont">Casper J. Hodiamont</name>
<affiliation><nlm:affiliation>Department of Medical Microbiology, Academic Medical Centre, Amsterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vonk, Alieke G" sort="Vonk, Alieke G" uniqKey="Vonk A" first="Alieke G" last="Vonk">Alieke G. Vonk</name>
<affiliation><nlm:affiliation>Department of Medical Microbiology, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Depuydt, Pieter" sort="Depuydt, Pieter" uniqKey="Depuydt P" first="Pieter" last="Depuydt">Pieter Depuydt</name>
<affiliation><nlm:affiliation>Department of Intensive Care Medicine, Ghent University, Ghent, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Boelens, Jerina" sort="Boelens, Jerina" uniqKey="Boelens J" first="Jerina" last="Boelens">Jerina Boelens</name>
<affiliation><nlm:affiliation>Department of Laboratory Medicine, and Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wauters, Joost" sort="Wauters, Joost" uniqKey="Wauters J" first="Joost" last="Wauters">Joost Wauters</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study.</title>
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<affiliation><nlm:affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Rijnders, Bart J A" sort="Rijnders, Bart J A" uniqKey="Rijnders B" first="Bart J A" last="Rijnders">Bart J A. Rijnders</name>
<affiliation><nlm:affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands. Electronic address: b.rijnders@erasmusmc.nl.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Philips, Nele" sort="Philips, Nele" uniqKey="Philips N" first="Nele" last="Philips">Nele Philips</name>
<affiliation><nlm:affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Verwijs, Rosanne" sort="Verwijs, Rosanne" uniqKey="Verwijs R" first="Rosanne" last="Verwijs">Rosanne Verwijs</name>
<affiliation><nlm:affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vanderbeke, Lore" sort="Vanderbeke, Lore" uniqKey="Vanderbeke L" first="Lore" last="Vanderbeke">Lore Vanderbeke</name>
<affiliation><nlm:affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Tienen, Carla" sort="Van Tienen, Carla" uniqKey="Van Tienen C" first="Carla" last="Van Tienen">Carla Van Tienen</name>
<affiliation><nlm:affiliation>Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Lagrou, Katrien" sort="Lagrou, Katrien" uniqKey="Lagrou K" first="Katrien" last="Lagrou">Katrien Lagrou</name>
<affiliation><nlm:affiliation>Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Verweij, Paul E" sort="Verweij, Paul E" uniqKey="Verweij P" first="Paul E" last="Verweij">Paul E. Verweij</name>
<affiliation><nlm:affiliation>Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Centre of Expertise in Mycology, Radboudumc/CWZ, Nijmegen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van De Veerdonk, Frank L" sort="Van De Veerdonk, Frank L" uniqKey="Van De Veerdonk F" first="Frank L" last="Van De Veerdonk">Frank L. Van De Veerdonk</name>
<affiliation><nlm:affiliation>Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Gommers, Diederik" sort="Gommers, Diederik" uniqKey="Gommers D" first="Diederik" last="Gommers">Diederik Gommers</name>
<affiliation><nlm:affiliation>Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Spronk, Peter" sort="Spronk, Peter" uniqKey="Spronk P" first="Peter" last="Spronk">Peter Spronk</name>
<affiliation><nlm:affiliation>Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Bergmans, Dennis C J J" sort="Bergmans, Dennis C J J" uniqKey="Bergmans D" first="Dennis C J J" last="Bergmans">Dennis C J J. Bergmans</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Maastricht University Medical Centre, Maastricht, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Hoedemaekers, Astrid" sort="Hoedemaekers, Astrid" uniqKey="Hoedemaekers A" first="Astrid" last="Hoedemaekers">Astrid Hoedemaekers</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Andrinopoulou, Eleni Rosalina" sort="Andrinopoulou, Eleni Rosalina" uniqKey="Andrinopoulou E" first="Eleni-Rosalina" last="Andrinopoulou">Eleni-Rosalina Andrinopoulou</name>
<affiliation><nlm:affiliation>Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Van Den Berg, Charlotte H S B" sort="Van Den Berg, Charlotte H S B" uniqKey="Van Den Berg C" first="Charlotte H S B" last="Van Den Berg">Charlotte H S B. Van Den Berg</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands; Department of Intensive Care, University Medical Center Groningen, Groningen, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Juffermans, Nicole P" sort="Juffermans, Nicole P" uniqKey="Juffermans N" first="Nicole P" last="Juffermans">Nicole P. Juffermans</name>
<affiliation><nlm:affiliation>Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Hodiamont, Casper J" sort="Hodiamont, Casper J" uniqKey="Hodiamont C" first="Casper J" last="Hodiamont">Casper J. Hodiamont</name>
<affiliation><nlm:affiliation>Department of Medical Microbiology, Academic Medical Centre, Amsterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vonk, Alieke G" sort="Vonk, Alieke G" uniqKey="Vonk A" first="Alieke G" last="Vonk">Alieke G. Vonk</name>
<affiliation><nlm:affiliation>Department of Medical Microbiology, Erasmus MC University Medical Center, Rotterdam, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Depuydt, Pieter" sort="Depuydt, Pieter" uniqKey="Depuydt P" first="Pieter" last="Depuydt">Pieter Depuydt</name>
<affiliation><nlm:affiliation>Department of Intensive Care Medicine, Ghent University, Ghent, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Boelens, Jerina" sort="Boelens, Jerina" uniqKey="Boelens J" first="Jerina" last="Boelens">Jerina Boelens</name>
<affiliation><nlm:affiliation>Department of Laboratory Medicine, and Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wauters, Joost" sort="Wauters, Joost" uniqKey="Wauters J" first="Joost" last="Wauters">Joost Wauters</name>
<affiliation><nlm:affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium.</nlm:affiliation>
</affiliation>
</author>
</analytic>
<series><title level="j">The Lancet. Respiratory medicine</title>
<idno type="eISSN">2213-2619</idno>
<imprint><date when="2018" type="published">2018</date>
</imprint>
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<term>Aged</term>
<term>Aspergillus</term>
<term>Belgium (epidemiology)</term>
<term>Female</term>
<term>Humans</term>
<term>Incidence</term>
<term>Influenza A virus</term>
<term>Influenza B virus</term>
<term>Influenza, Human (epidemiology)</term>
<term>Influenza, Human (microbiology)</term>
<term>Intensive Care Units (statistics & numerical data)</term>
<term>Invasive Pulmonary Aspergillosis (epidemiology)</term>
<term>Invasive Pulmonary Aspergillosis (microbiology)</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Netherlands (epidemiology)</term>
<term>Odds Ratio</term>
<term>Patient Admission (statistics & numerical data)</term>
<term>Retrospective Studies</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Belgium</term>
<term>Netherlands</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Influenza, Human</term>
<term>Invasive Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Influenza, Human</term>
<term>Invasive Pulmonary Aspergillosis</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Intensive Care Units</term>
<term>Patient Admission</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>APACHE</term>
<term>Aged</term>
<term>Aspergillus</term>
<term>Female</term>
<term>Humans</term>
<term>Incidence</term>
<term>Influenza A virus</term>
<term>Influenza B virus</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Odds Ratio</term>
<term>Retrospective Studies</term>
</keywords>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no 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] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).</p>
</div>
<div type="abstract" xml:lang="en"><p><b>FINDINGS</b>
</p>
<p>Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>INTERPRETATION</b>
</p>
<p>Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>FUNDING</b>
</p>
<p>None.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2019</Year>
<Month>06</Month>
<Day>24</Day>
</DateCompleted>
<DateRevised><Year>2019</Year>
<Month>06</Month>
<Day>24</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2213-2619</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>6</Volume>
<Issue>10</Issue>
<PubDate><Year>2018</Year>
<Month>10</Month>
</PubDate>
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<Title>The Lancet. Respiratory medicine</Title>
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<ArticleTitle>Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study.</ArticleTitle>
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<ELocationID EIdType="pii" ValidYN="Y">S2213-2600(18)30274-1</ELocationID>
<ELocationID EIdType="doi" ValidYN="Y">10.1016/S2213-2600(18)30274-1</ELocationID>
<Abstract><AbstractText Label="BACKGROUND">Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.</AbstractText>
<AbstractText Label="METHODS">We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no 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] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).</AbstractText>
<AbstractText Label="FINDINGS">Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.</AbstractText>
<AbstractText Label="INTERPRETATION">Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.</AbstractText>
<AbstractText Label="FUNDING">None.</AbstractText>
<CopyrightInformation>Copyright © 2018 Elsevier Ltd. All rights reserved.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Schauwvlieghe</LastName>
<ForeName>Alexander F A D</ForeName>
<Initials>AFAD</Initials>
<AffiliationInfo><Affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Rijnders</LastName>
<ForeName>Bart J A</ForeName>
<Initials>BJA</Initials>
<AffiliationInfo><Affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands. Electronic address: b.rijnders@erasmusmc.nl.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Philips</LastName>
<ForeName>Nele</ForeName>
<Initials>N</Initials>
<AffiliationInfo><Affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Verwijs</LastName>
<ForeName>Rosanne</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Vanderbeke</LastName>
<ForeName>Lore</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Van Tienen</LastName>
<ForeName>Carla</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Lagrou</LastName>
<ForeName>Katrien</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Verweij</LastName>
<ForeName>Paul E</ForeName>
<Initials>PE</Initials>
<AffiliationInfo><Affiliation>Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Centre of Expertise in Mycology, Radboudumc/CWZ, Nijmegen, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Van de Veerdonk</LastName>
<ForeName>Frank L</ForeName>
<Initials>FL</Initials>
<AffiliationInfo><Affiliation>Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gommers</LastName>
<ForeName>Diederik</ForeName>
<Initials>D</Initials>
<AffiliationInfo><Affiliation>Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Spronk</LastName>
<ForeName>Peter</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bergmans</LastName>
<ForeName>Dennis C J J</ForeName>
<Initials>DCJJ</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care, Maastricht University Medical Centre, Maastricht, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Hoedemaekers</LastName>
<ForeName>Astrid</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Andrinopoulou</LastName>
<ForeName>Eleni-Rosalina</ForeName>
<Initials>ER</Initials>
<AffiliationInfo><Affiliation>Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>van den Berg</LastName>
<ForeName>Charlotte H S B</ForeName>
<Initials>CHSB</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands; Department of Intensive Care, University Medical Center Groningen, Groningen, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Juffermans</LastName>
<ForeName>Nicole P</ForeName>
<Initials>NP</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Hodiamont</LastName>
<ForeName>Casper J</ForeName>
<Initials>CJ</Initials>
<AffiliationInfo><Affiliation>Department of Medical Microbiology, Academic Medical Centre, Amsterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Vonk</LastName>
<ForeName>Alieke G</ForeName>
<Initials>AG</Initials>
<AffiliationInfo><Affiliation>Department of Medical Microbiology, Erasmus MC University Medical Center, Rotterdam, Netherlands.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Depuydt</LastName>
<ForeName>Pieter</ForeName>
<Initials>P</Initials>
<AffiliationInfo><Affiliation>Department of Intensive Care Medicine, Ghent University, Ghent, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Boelens</LastName>
<ForeName>Jerina</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Department of Laboratory Medicine, and Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wauters</LastName>
<ForeName>Joost</ForeName>
<Initials>J</Initials>
<AffiliationInfo><Affiliation>Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><CollectiveName>Dutch-Belgian Mycosis study group</CollectiveName>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D016448">Multicenter Study</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2018</Year>
<Month>07</Month>
<Day>31</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>England</Country>
<MedlineTA>Lancet Respir Med</MedlineTA>
<NlmUniqueID>101605555</NlmUniqueID>
<ISSNLinking>2213-2600</ISSNLinking>
</MedlineJournalInfo>
<CitationSubset>IM</CitationSubset>
<CommentsCorrectionsList><CommentsCorrections RefType="CommentIn"><RefSource>Lancet Respir Med. 2018 Oct;6(10):733-735</RefSource>
<PMID Version="1">30076120</PMID>
</CommentsCorrections>
</CommentsCorrectionsList>
<MeshHeadingList><MeshHeading><DescriptorName UI="D018806" MajorTopicYN="N">APACHE</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D001230" MajorTopicYN="Y">Aspergillus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D001530" MajorTopicYN="N" Type="Geographic">Belgium</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015994" MajorTopicYN="N">Incidence</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D009980" MajorTopicYN="Y">Influenza A virus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D009981" MajorTopicYN="Y">Influenza B virus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D007251" MajorTopicYN="N">Influenza, Human</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D007362" MajorTopicYN="N">Intensive Care Units</DescriptorName>
<QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D055744" MajorTopicYN="N">Invasive Pulmonary Aspergillosis</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D009426" MajorTopicYN="N" Type="Geographic">Netherlands</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016017" MajorTopicYN="N">Odds Ratio</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D010343" MajorTopicYN="N">Patient Admission</DescriptorName>
<QualifierName UI="Q000706" MajorTopicYN="N">statistics & numerical data</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
</MeshHeadingList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2018</Year>
<Month>04</Month>
<Day>25</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="revised"><Year>2018</Year>
<Month>06</Month>
<Day>11</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted"><Year>2018</Year>
<Month>06</Month>
<Day>15</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed"><Year>2018</Year>
<Month>8</Month>
<Day>5</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline"><Year>2019</Year>
<Month>6</Month>
<Day>25</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez"><Year>2018</Year>
<Month>8</Month>
<Day>5</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>ppublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">30076119</ArticleId>
<ArticleId IdType="pii">S2213-2600(18)30274-1</ArticleId>
<ArticleId IdType="doi">10.1016/S2213-2600(18)30274-1</ArticleId>
</ArticleIdList>
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