Invasive aspergillosis in critically ill patients without malignancy

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Mycology

Background:

• Invasive aspergillosis (IA) is typically studied in cancer patients.
• Its impact on non-malignant patients in intensive care units (ICUs) is less understood.
• Current diagnostic criteria for IA were developed for immunocompromised cancer patients.

Purpose of the Study:

• To evaluate the impact and outcomes of IA in medical ICU patients without malignancy.
• To assess the applicability of existing IA diagnostic criteria in this population.
• To highlight IA as an emerging infectious disease in non-hematologic critically ill patients.

Main Methods:

• Retrospective analysis of 1,850 ICU admissions between 2000 and 2003.
• Identification of patients with microbiological or histopathologic evidence of Aspergillus.
• Classification of cases into proven, probable, possible IA, or colonization based on established criteria.

Main Results:

• Out of 1,850 admissions, 127 (6.9%) had Aspergillus evidence; 89 (70%) were without hematologic malignancy.
• In non-malignant patients, overall mortality was 80% (71/89).
• Mortality for proven IA was 97% and for probable IA was 87%.

Conclusions:

• Invasive aspergillosis is a devastating infection in critically ill patients without malignancy.
• Observed mortality rates are significantly high, even in cases lacking traditional predisposing factors.
• Host criteria for diagnosing probable fungal infections in ICUs may require adaptation for non-malignant patients.