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Updated: Jul 18, 2026
Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome
Faisal Khasawneh1, Tamam Mohamad, Mahmoud K Moughrabieh
1Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA.
Objective:
Recent reports have suggested a rising incidence of pulmonary aspergillosis in intensive care unit (ICU) patients. The aim of this study was to determine the clinical significance of isolating Aspergillus from respiratory samples of critically ill patients.
Design:
Retrospective review of medical records.
Setting:
Tertiary medical center that has a large cancer center.
Patients:
All patients admitted to the ICU between January 1998 and August 2004, in whom Aspergillus was isolated from respiratory samples or lung tissue.
Intervention:
None.
Results:
The charts of 104 patients were reviewed. Aspergillus was isolated for a mean of 6.6 days after ICU admission. Thirty-three percent of patients had hematological malignancy, 10% had absolute neutropenia, 14% had bone marrow transplant, 11% had HIV infection, and 22% had chronic obstructive pulmonary disease. Upon admission to ICU, 79%, 43%, and 19% were on antibiotics, corticosteroids, or immunosuppressive therapy, respectively. Ninety percent of patients required mechanical ventilation. The mean Acute Physiologic and Chronic Health Evaluation II score on ICU admission was 20.6, with predicted mortality of 35.5%. However, the actual ICU mortality rate for the cohort was 50%. Twenty-eight percent of patients were diagnosed with probable or definite invasive pulmonary aspergillosis, and 72% had Aspergillus colonization. On univariate analysis, the significant clinical differences between the 2 groups were the presence of neutropenia (P < .05), immunosuppressants (P < .05), antibiotics (P < .05), or bone marrow transplant (P < .05). The differences in Acute Physiologic and Chronic Health Evaluation II score, the need for mechanical ventilation, ICU length of stay, and ICU mortality were not statistically significant. On multivariate analysis, the following factors were independently associated with invasive diseases, bone marrow transplantation (P < .01), hematological malignancy (P = .02), and broad-spectrum antibiotics (P = .02).
Conclusion:
Isolation of Aspergillus in critically ill patients is a poor prognostic marker and is associated with high mortality irrespective of invasion or colonization. Those who are neutropenic, on immunosuppressive therapy, on broad-spectrum antibiotics, or had bone marrow transplantation are more likely to have invasive pulmonary aspergillosis.
Insights
Isolating Aspergillus in intensive care unit (ICU) patients indicates a poor prognosis and high mortality. Risk factors for invasive pulmonary aspergillosis include neutropenia, immunosuppression, and bone marrow transplant.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Pulmonary aspergillosis incidence is rising in intensive care unit (ICU) patients.
- Aspergillus isolation from respiratory samples in critically ill patients warrants clinical significance assessment.
Purpose of the Study:
- To determine the clinical significance of isolating Aspergillus from respiratory samples of critically ill patients.
- To identify risk factors associated with invasive pulmonary aspergillosis in the ICU.
Main Methods:
- Retrospective review of medical records from a tertiary medical center with a large cancer center.
- Analysis of 104 ICU patients from January 1998 to August 2004 with Aspergillus isolated from respiratory samples or lung tissue.
Main Results:
- Aspergillus isolation occurred a mean of 6.6 days post-ICU admission.
- 50% ICU mortality rate observed, higher than predicted (35.5%).
- Invasive pulmonary aspergillosis diagnosed in 28% of patients; 72% had colonization. Factors associated with invasive disease included bone marrow transplantation, hematological malignancy, and broad-spectrum antibiotics.
Conclusions:
- Isolation of Aspergillus is a poor prognostic marker in critically ill patients, associated with high mortality regardless of invasion or colonization.
- Neutropenia, immunosuppressive therapy, broad-spectrum antibiotics, and bone marrow transplantation increase the likelihood of invasive pulmonary aspergillosis.
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