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Updated: Sep 3, 2026
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter,
Antoine Villa1, Benoit Painvin2, Antoine Hérault3,4,5
1Service de Médecine Intensive Réanimation, DMU Médecine, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Background:
Suspected invasive pulmonary aspergillosis (IPA) is increasingly treated in intensive care, including in patients without classical immunosuppression. Whether current research definitions (European Organization for Research and Treatment of Cancer [EORTC]/Mycoses Study Group Education and Research Consortium (MSGERC), Invasive Fungal Diseases in Adult Patients in ICU [FUNDICU]) classify treated cases and predict mortality is unclear.
Methods:
We retrospectively included adults in 48 French intensive care units who received systemic antifungal therapy for suspected IPA (January 2022 to July 2024). Patients were categorized as having modified EORTC/MSGERC probable IPA, FUNDICU probable IPA, or unclassified. Ninety-day mortality was analyzed using multivariable Cox regression; heterogeneity was explored with unsupervised clustering.
Results:
Among 371 treated patients, 217 (58%) met modified EORTC, 83 (22%) met FUNDICU, and 71 (19%) were unclassified. Overall, 90-day mortality was 62% and mortality did not differ by category (63%, 63%, 58%; log-rank P = .24). In adjusted analyses, IPA categorization was not associated with mortality (FUNDICU vs EORTC: adjusted hazard ratio [aHR] = 0.86, 95% CI .62-1.20; unclassified vs EORTC: aHR = 0.89, .62-1.30). Age (aHR 1.03/year, 1.02-1.05), Sequential Organ Failure Assessment (1.06/point, 1.03-1.10), and frailty (1.17/point, 1.07-1.30) independently predicted 90-day mortality. Exploratory clustering identified 6 phenotypes with 90-day mortality ranging from 40% to 80%.
Conclusions:
Nearly 1 in 5 intensive care patients treated for suspected IPA were not classifiable by EORTC/MSGERC or FUNDICU definitions. Mortality was more strongly associated with age, frailty, and acute severity than with classification category, supporting ICU-focused diagnostic frameworks and risk stratification; these associations should be read in light of the treatment-based design and do not establish that the definitions lack diagnostic value.
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