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Published on: March 9, 2018
[Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the intensive care units]
F Álvarez Lerma1, P Olaechea Astigarraga2, M Palomar Martínez3
1Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
Unlabelled:
The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality.
Objectives:
To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection.
Material And Methods:
An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis.
Results:
A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76).
Conclusions:
Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
Insights
Respiratory fungal infections caused by Aspergillus spp. in Spanish intensive care units (ICUs) are infrequent but linked to high mortality. Risk factors include prior hospital ward admission, immunosuppression, and severe sepsis.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Mycology
Background:
- Respiratory fungal infections, particularly those caused by Aspergillus spp., pose significant morbidity and mortality risks in critically ill patients.
- Early identification and management are crucial for improving outcomes in intensive care unit (ICU) settings.
Purpose of the Study:
- To determine the incidence of Aspergillus spp. respiratory infections in Spanish ICUs, irrespective of infection origin.
- To characterize the clinical presentation, outcomes, and prognostic factors associated with these infections.
Main Methods:
- An observational, retrospective, multicenter study analyzed data from 108,244 patients in the ENVIN-HELICS registry (2006-2012).
- Included patients had confirmed Aspergillus spp. respiratory infections in Spanish ICUs.
- Logistic regression identified independent predictors of in-hospital mortality.
Main Results:
- The study identified 267 cases of Aspergillus spp. respiratory infections (2.46 per 1000 ICU patients).
- Common presentations included ventilator-associated pneumonia (34.8%) and pneumonia unrelated to ventilation (44.9%).
- High ICU (57.3%) and hospital (59.6%) mortality rates were observed, with independent risk factors being prior hospital ward admission, immunosuppression, and severe sepsis/septic shock.
Conclusions:
- Aspergillus spp. respiratory infections are uncommon in Spanish ICUs but affect a vulnerable patient subset.
- These infections are associated with substantial mortality, influenced by non-modifiable risk factors.
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