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Invasive aspergillosis in critically ill patients: An autopsy study
Eva E Tejerina1, Elena Abril2, Rebeca Padilla2
1Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain.
Mycoses
|June 10, 2019
Summary
Invasive aspergillosis (IA) is frequently missed in critically ill patients. High-dose corticosteroids, especially in COPD patients with respiratory issues, significantly increase IA risk.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pathology
Background:
- Invasive aspergillosis (IA) is a common, yet often missed, diagnosis in intensive care unit (ICU) patients.
- Diagnostic challenges persist due to a lack of definitive ante-mortem criteria.
Purpose of the Study:
- To investigate the epidemiology and clinical risk factors associated with IA in critically ill patients.
- To identify patient subgroups at higher risk for developing IA.
Main Methods:
- Retrospective observational study of ICU patients with autopsy-confirmed IA.
- Analysis of 893 postmortem examinations over a 25-year period.
- Review of patient comorbidities and clinical data.
Main Results:
- IA was diagnosed in 2.8% (25/893) of autopsies.
- Only 40% of IA cases were suspected ante-mortem.
- Common risk factors included corticosteroid treatment (56%), COPD (44%), and immunosuppression (24%).
- 92% of patients had three or more risk factors for IA.
Conclusions:
- IA is underdiagnosed in critically ill patients.
- High-dose corticosteroid use, particularly in COPD patients with worsening respiratory failure, elevates IA risk.
- Pulmonary infiltrates in conjunction with these risk factors warrant heightened clinical suspicion for IA.
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