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[Invasive aspergillosis in surgical intensive care patients]
Y Blanloeil1, T François, P Germaud
1Département d'Anesthésie-Réanimation, Hôpital G et R Laënnec, CHU, Nantes.
Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1993
Summary
Invasive aspergillosis is rare in intensive care units. Itraconazole bioavailability may be poor in critically ill patients, requiring dose monitoring and potential combination therapy.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Aspergillosis is an uncommon but serious fungal infection, particularly in immunocompromised patients.
- This study examines three cases of invasive aspergillosis in a surgical critical care unit.
Observation:
- Two cases involved liver transplant recipients with risk factors for aspergillosis.
- One patient experienced treatment challenges due to the lack of injectable itraconazole.
- A third case occurred in a patient with gastric carcinoma and liver metastasis.
Findings:
- Environmental sampling revealed Aspergillus species in patient rooms.
- Low plasma itraconazole concentrations were observed, likely due to gastrointestinal disturbances.
- Oral itraconazole via feeding tubes showed poor drug bioavailability.
Implications:
- Higher itraconazole doses and plasma concentration monitoring are recommended for patients with impaired intestinal absorption.
- Combination therapy with amphotericin B may be necessary until intestinal absorption normalizes.
- This highlights the challenges in managing invasive aspergillosis in critically ill patients.