Aspergillosis: Emerging risk groups in critically ill patients

Area of Science:

• Critical care medicine
• Mycology
• Infectious diseases

Background:

• Invasive aspergillosis (IA) data is limited in non-neutropenic ICU patients without classic risk factors.
• Corticosteroid use for conditions like COPD, sepsis, or COVID-19 is a primary risk factor for IA in ICU settings.
• Other key host factors include COPD, liver failure, and severe viral pneumonia (influenza, COVID-19).

Purpose of the Study:

• To review risk factors for invasive aspergillosis in intensive care unit (ICU) patients.
• To emphasize often overlooked conditions contributing to IA development in ICU patients.
• To discuss current approaches to IA prophylaxis and treatment in critically ill patients.

Main Methods:

• Critical appraisal of relevant literature.
• Incorporation of authors' clinical experience.
• Discussions from a consensus conference.

Main Results:

• Corticosteroid use is a cardinal risk factor for IA in ICU patients.
• COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia are significant host risk factors.
• Sepsis and small molecule inhibitors in oncology may also be direct risk factors for IA.

Conclusions:

• Combined evaluation of clinical signs, imaging, biomarkers (GM assay), and cultures is optimal for assessing IA treatment response.
• No specific prophylaxis recommendations exist for ICU patients; treatment mirrors that for other populations.
• Identifying and managing risk factors like corticosteroid use and co-morbidities is crucial for preventing IA in ICU settings.