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Invasive pulmonary aspergillosis among patients with severe community-acquired pneumonia and influenza in ICUs: a retrospective cohort study.
Lee, Wei-Chun; Chang, Che-Chia; Ho, Meng-Chin; Lin, Chieh-Mo; Leu, Shaw-Woei; Lin, Chin-Kuo; Fang, Yu-Hung; Huang, Shu-Yi; Lin, Yu-Ching; Chuang, Min-Chun; Yang, Tsung-Ming; Hung, Ming-Szu; Chou, Yen-Li; Tsai, Ying-Huang; Hsieh, Meng-Jer.
Afiliación
  • Lee WC; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Chang CC; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Ho MC; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Lin CM; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Leu SW; Department of Pulmonary and Critical Care Medicine, Chang-Gung Medical Foundation, Linkou Chang-Gung Memorial Hospital, No.5, Fuxing St., Guishan Dist., Taoyuan, 333, Taiwan (ROC).
  • Lin CK; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Fang YH; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Huang SY; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Lin YC; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Chuang MC; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
  • Yang TM; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Hung MS; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Chou YL; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
  • Tsai YH; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan.
  • Hsieh MJ; Department of Pulmonary and Critical Care Medicine, Chiayi Chang-Gung Memorial Hospital, Chang-Gung Medical Foundation, Chiayi, Taiwan.
Pneumonia (Nathan) ; 16(1): 10, 2024 May 25.
Article en En | MEDLINE | ID: mdl-38790032
ABSTRACT
RATIONALE The prevalence, clinical characteristics, and outcomes of invasive pulmonary aspergillosis in patients with severe community-acquired pneumonia (CAP) in intensive care units remain underestimated because of the lack of a disease-recognition scheme and the inadequacy of diagnostic tests.

OBJECTIVES:

To identify the prevalence, risk factors, and outcomes of severe CAP complicated with invasive pulmonary aspergillosis (IPA) in intensive care units (ICUs).

METHODS:

We conducted a retrospective cohort study including recruited 311 ICU-hospitalized patients with severe CAP without influenza or with influenza. Bronchoalveolar lavage fluid (BALF) samples were from all patients and subjected to mycological testing. Patients were categorized as having proven or probable Aspergillus infection using a modified form of the AspICU algorithm comprising clinical, radiological, and mycological criteria. MEASUREMENTS AND MAIN

RESULTS:

Of the 252 patients with severe CAP and 59 influenza patients evaluated, 24 met the diagnostic criteria for proven or probable Aspergillus infection in the CAP group and 9 patients in the influenza group, giving estimated prevalence values of 9.5% and 15.3%, respectively. COPD and the use of inhaled corticosteroids were independent risk factors for IPA. IPA in patients with severe CAP was significantly associated with the duration of mechanical support, the length of ICU stay, and the 28-day mortality.

CONCLUSIONS:

An aggressive diagnostic approach for IPA patients with severe CAP and not only influenza or COVID-19 should be pursued. Further randomized controlled trials need to evaluate the timing, safety, and efficacy of antifungal therapy in reducing IPA incidence and improving clinical outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pneumonia (Nathan) Año: 2024 Tipo del documento: Article País de afiliación: Taiwán

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Pneumonia (Nathan) Año: 2024 Tipo del documento: Article País de afiliación: Taiwán
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