Related Experiment Videos
[Invasive aspergillosis in surgical intensive care patients]
Y Blanloeil1, T François, P Germaud
1Département d'Anesthésie-Réanimation, Hôpital G et R Laënnec, CHU, Nantes.
Abstract:
Aspergillosis is a rare event in intensive care patients. Three cases of invasive aspergillosis due to Aspergillus fumigatus were diagnosed in a surgical critical care unit. Risk factors for aspergillosis were found in two liver transplanted patients. One of them had a primitive cutaneous aspergillosis, and the other, treatment difficulties due to the unavailability of an injectable preparation of itraconazole, a new triazole antifungal agent efficient against Aspergillus species. The third case occurred in a patient who had had surgery for gastric carcinoma with liver metastasis. The mycological examination of the air and workbench in the patients' rooms disclosed between 2 and 13 CFU.mm-3 of different Aspergillus species. Plasma itraconazole concentrations were measured in one patient only. They were below the therapeutic range, probably because of intestinal disturbances. The oral administration of itraconazole capsules through gastro-intestinal feeding tubes results in a poor availability of the drug. Such a technique of administration should therefore be undertaken with larger doses than those commonly recommended. Moreover, itraconazole plasma concentrations should be monitored. The association with amphotericin B is recommended until normal intestinal absorption has been obtained.
Insights
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.