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Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS, Tayade A, Bhandari S, Gella V, Savio J, Madan S, Hallur V, Maturu VN, Srinivasan A, Sethuraman N, Sibia RPS, Pujari S, Mehta R, Singhal T, Saxena P, Gupta V, Nagvekar V, Prayag P, Patel D, Xess I, Savaj P, Sehgal IS, Panda N, Rajagopal GD, Parwani RS, Patel K, Deshmukh A, Vyas A, Gandra RR, Sistla SK, Padaki PA, Ramar D, Panigrahi MK, Sarkar S, Rachagulla B, Vallandaramam P, Premachandran KP, Pawar S, Gugale P, Hosamani P, Dutt SN, Nair S, Kalpakkam H, Badhwar S, Kompella KK, Singla N, Navlakhe M, Prayag A, Singh G, Dhakecha P, Chakrabarti A. Prevalence of co-existent COVID-19-associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID-19-associated pulmonary mucormycosis (CAPM). Mycoses 2024; 67:e13745. [PMID: 38767273 DOI: 10.1111/myc.13745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse. OBJECTIVES To ascertain the prevalence of co-existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis). METHODS We retrospectively analysed the data collected from 25 centres across India on COVID-19-associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino-orbital mucormycosis. We defined co-existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID-19, and management of CAPM patients with and without CAPA. Using a case-control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM. RESULTS We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co-existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62-139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID-19 and other factors. CONCLUSION Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.
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Affiliation(s)
- Valliappan Muthu
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | | | | | - Vishwanath Gella
- Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Jayanthi Savio
- St. John's Medical College and Hospital, Bangalore, Karnataka, India
| | - Surabhi Madan
- Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | | | | | | | | | | | - Sanjay Pujari
- Poona Hospital and Research Centre, Pune, Maharashtra, India
| | | | - Tanu Singhal
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Puneet Saxena
- Army Hospital (Research and Referral), New Delhi, India
| | | | | | | | - Dharmesh Patel
- City Clinic and Bhailal Amin General Hospital, Vadodara, Gujarat, India
| | | | - Pratik Savaj
- Institute of Infectious Disease and Critical Care Hospital, Surat, Gujarat, India
| | | | - Naresh Panda
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | - Aruna Vyas
- Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | | | | | | | - Dharshni Ramar
- Care Institute of Medical Sciences, Ahmedabad, Gujarat, India
| | | | - Saurav Sarkar
- All India Institute of Medical Science Bhubaneswar, Odisha, India
| | | | | | | | - Sunil Pawar
- Government Medical College, Patiala, Punjab, India
| | - Piyush Gugale
- Poona Hospital and Research Centre, Pune, Maharashtra, India
| | | | | | - Satish Nair
- Apollo Hospitals, Bengaluru, Karnataka, India
| | | | - Sanjiv Badhwar
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | | | | | | | | | | | - Poorvesh Dhakecha
- Institute of Infectious Disease and Critical Care Hospital, Surat, Gujarat, India
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2
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Kreitmann L, Helms J, Martin-Loeches I, Salluh J, Poulakou G, Pène F, Nseir S. ICU-acquired infections in immunocompromised patients. Intensive Care Med 2024; 50:332-349. [PMID: 38197931 DOI: 10.1007/s00134-023-07295-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/25/2023] [Indexed: 01/11/2024]
Abstract
Immunocompromised patients account for an increasing proportion of the typical intensive care unit (ICU) case-mix. Because of the increased availability of new drugs for cancer and auto-immune diseases, and improvement in the care of the most severely immunocompromised ICU patients (including those with hematologic malignancies), critically ill immunocompromised patients form a highly heterogeneous patient population. Furthermore, a large number of ICU patients with no apparent immunosuppression also harbor underlying conditions altering their immune response, or develop ICU-acquired immune deficiencies as a result of sepsis, trauma or major surgery. While infections are associated with significant morbidity and mortality in immunocompromised critically ill patients, little specific data are available on the incidence, microbiology, management and outcomes of ICU-acquired infections in this population. As a result, immunocompromised patients are usually excluded from trials and guidelines on the management of ICU-acquired infections. The most common ICU-acquired infections in immunocompromised patients are ventilator-associated lower respiratory tract infections (which include ventilator-associated pneumonia and tracheobronchitis) and bloodstream infections. Recently, several large observational studies have shed light on some of the epidemiological specificities of these infections-as well as on the dynamics of colonization and infection with multidrug-resistant bacteria-in these patients, and these will be discussed in this review. Immunocompromised patients are also at higher risk than non-immunocompromised hosts of fungal and viral infections, and the diagnostic and therapeutic management of these infections will be covered. Finally, we will suggest some important areas of future investigation.
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Affiliation(s)
- Louis Kreitmann
- Department of Intensive Care Medicine, Imperial College Healthcare NHS Trust, London, UK
- Centre for Antimicrobial Optimisation, Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, W12 0HS, UK
| | - Julie Helms
- Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1, Place de l'Hôpital, 67091, Strasbourg Cedex, France
- ImmunoRhumatologie Moléculaire, INSERM UMR_S1109, LabEx TRANSPLANTEX, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Fédération Hospitalo-Universitaire (FHU) OMICARE, Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), Leinster, D08NYH1, Dublin, Ireland
- Pulmonary Intensive Care Unit, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, ICREA CIBERes, 08380, Barcelona, Spain
| | - Jorge Salluh
- D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Rio de Janeiro, RJ, 22281-100, Brazil
| | - Garyphallia Poulakou
- Third Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria General Hospital, Athens, Greece
| | - Frédéric Pène
- Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU de Lille, 59000, Lille, France.
- Inserm U1285, Université de Lille, CNRS, UMR 8576-UGSF, 59000, Lille, France.
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Tourabi M, Nouioura G, Touijer H, Baghouz A, El Ghouizi A, Chebaibi M, Bakour M, Ousaaid D, Almaary KS, Nafidi HA, Bourhia M, Farid K, Lyoussi B, Derwich E. Antioxidant, Antimicrobial, and Insecticidal Properties of Chemically Characterized Essential Oils Extracted from Mentha longifolia: In Vitro and In Silico Analysis. PLANTS (BASEL, SWITZERLAND) 2023; 12:3783. [PMID: 37960139 PMCID: PMC10650643 DOI: 10.3390/plants12213783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
The present study aimed to explore the phytochemical profile, and evaluate the antioxidant, antimicrobial, and insecticidal properties, of Moroccan Mentha longifolia L. essential oil (ML-EO) using in vitro and in silico assays. Noteworthily, as chromatography (GC-MS/MS) revealed that ML-EO is majorly composed of piperitenone oxide (53.43%), caryophyllene (20.02%), and (-) germacrene D (16.53%). It possesses excellent antioxidant activity with an IC50 of 1.49 ± 0.00 for DPPH and 0.051 ± 0.06 μg/mL for ABTS. Moreover, the RP and TAC activities were 0.80 ± 0.01 μg/mL and 315.532 ± 0.00 mg EAA/g, respectively. ML-EO exhibited a potent antimicrobial effect, specifically against Pseudomonas aeruginosa. It also exhibited strong antifungal ability, especially against Candida albicans. Regarding insecticidal activity, for ML-EO, a dose of 20 µL/mL produced a complete reduction in fecundity, fertility, and emergence of adult C. maculatus with mortality rates reaching 100%. In silico results showed that the antioxidant activity is mostly attributed to α-Cadinol, the antibacterial efficiency is attributed to piperitenone oxide, and antifungal capacity is related to cis-Muurola-4(15),5-diene and piperitenone oxide. Accordingly, ML-EO has high potential to be used as an alternative for preserving food and stored grain and protecting them against microbes and insect pests in the food and pharmaceutical sectors.
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Affiliation(s)
- Meryem Tourabi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
| | - Ghizlane Nouioura
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
| | - Hanane Touijer
- Laboratory of Biotechnology, Environment, Agri-Food and Health, Faculty of Sciences Dhar El Mahraz, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco;
| | - Asmae Baghouz
- Laboratory of Biotechnology, Conservation, and Valorization of Natural Resources, Department of Biology, Faculty of Science Dhar El Mahraz, University of Sidi Mohamed Ben Abdellah, B.P. 1796 Atlas, Fez 30003, Morocco;
| | - Asmae El Ghouizi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
- Ministry of Health and Social Protection, Higher Institute of Nursing Professions and Health Techniques, Fez 30000, Morocco;
| | - Mohamed Chebaibi
- Ministry of Health and Social Protection, Higher Institute of Nursing Professions and Health Techniques, Fez 30000, Morocco;
- Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco
| | - Meryem Bakour
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
- Ministry of Health and Social Protection, Higher Institute of Nursing Professions and Health Techniques, Fez 30000, Morocco;
| | - Driss Ousaaid
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
| | - Khalid S. Almaary
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia;
| | - Hiba-Allah Nafidi
- Department of Food Science, Faculty of Agricultural and Food Sciences, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Mohammed Bourhia
- Department of Chemistry and Biochemistry, Faculty of Medicine and Pharmacy, Ibn Zohr University, Laayoune 70000, Morocco
| | - Khallouki Farid
- Ethnopharmacology and Pharmacognosy Team, Department of Biology, Moulay Ismail University of Meknes, Errachidia 52000, Morocco;
| | - Badiaa Lyoussi
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
| | - Elhoussine Derwich
- Laboratory of Natural Substances, Pharmacology, Environment, Modeling, Health & Quality of Life, Faculty of Sciences, Sidi Mohamed Ben Abdellah University, Fez 30003, Morocco; (M.T.); (G.N.); (A.E.G.); (M.B.); (D.O.); (B.L.); (E.D.)
- Unity of GC/MS, GC-FID, City of Innovation, Sidi Mohamed bin Abdellah University, Fez 30003, Morocco
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4
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Corcione S, Lupia T, Raviolo S, Montrucchio G, Trentalange A, Curtoni A, Cavallo R, De Rosa FG. Putative invasive pulmonary aspergillosis within medical wards and intensive care units: a 4-year retrospective, observational, single-centre study. Intern Emerg Med 2021; 16:1619-1627. [PMID: 33751395 PMCID: PMC8354984 DOI: 10.1007/s11739-021-02705-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
Blot and colleagues have proposed putative invasive pulmonary aspergillosis (PIPA) definitions for troublesome diagnosis in suspected patients outside the classical criteria of immunosuppression. We retrospectively included in the study all admitted patients with an Aspergillus spp. positive culture within lower airway samples. Overall, Aspergillus spp. positivity in respiratory samples was 0.97 every 1000 hospital admissions (HA): 4.94 and 0.28/1000/HA, respectively, in intensive care units (ICUs) and medical wards (MW). 66.6% fulfilled PIPA criteria, and 33.4% were defined as colonized. 69.2% of PIPA diagnosis occurred in the ICU. Antifungal therapy was appropriate in 88.5% of subjects with PIPA and 37.5% of colonized, confirming the comparison between deads and lives. Patients with PIPA in the ICUs had more frequent COPD, sepsis or septic shock, acute kidney injury (AKI), needed more surgery, mechanical ventilation (MV), vasopressors, hemodialysis, blood or platelets transfusions. PIPA in MW had associated with a history of smoking, interstitial lung disease and inhaled steroid therapy. Overall mortality within 21 days was 50%: 54.2% in ICU, 36,8% in MW. Factors associated with death were length of hospitalization, influenza, pneumonia, liver transplant, AKI, ARDS, sepsis and septic shock. PIPA in the ICU had higher disease severity and needed more organ support than MW cases, despite that cases of PIPA in MW are emerging with trends difficult to demonstrate given the problematic diagnosis.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- Tufts University School of Medicine, Boston, USA
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
| | - Stefania Raviolo
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Giorgia Montrucchio
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Alice Trentalange
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Antonio Curtoni
- Microbiology and Virology Unit, University of Turin, Turin, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University of Turin, Turin, Italy
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5
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Abstract
Pulmonary infection is one of the main complications occurring in patients suffering from acute respiratory distress syndrome (ARDS). Besides traditional risk factors, dysregulation of lung immune defenses and microbiota may play an important role in ARDS patients. Prone positioning does not seem to be associated with a higher risk of pulmonary infection. Although bacteria associated with ventilator-associated pneumonia (VAP) in ARDS patients are similar to those in patients without ARDS, atypical pathogens (Aspergillus, herpes simplex virus and cytomegalovirus) may also be responsible for infection in ARDS patients. Diagnosing pulmonary infection in ARDS patients is challenging, and requires a combination of clinical, biological and microbiological criteria. The role of modern tools (e.g., molecular methods, metagenomic sequencing, etc.) remains to be evaluated in this setting. One of the challenges of antimicrobial treatment is antibiotics diffusion into the lungs. Although targeted delivery of antibiotics using nebulization may be interesting, their place in ARDS patients remains to be explored. The use of extracorporeal membrane oxygenation in the most severe patients is associated with a high rate of infection and raises several challenges, diagnostic issues and pharmacokinetics/pharmacodynamics changes being at the top. Prevention of pulmonary infection is a key issue in ARDS patients, but there is no specific measure for these high-risk patients. Reinforcing preventive measures using bundles seems to be the best option.
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Ramírez P, Garnacho-Montero J. [Invasive aspergillosis in critically ill patients]. Rev Iberoam Micol 2019; 35:210-216. [PMID: 30554674 DOI: 10.1016/j.riam.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/11/2018] [Accepted: 07/24/2018] [Indexed: 01/06/2023] Open
Abstract
Critically ill patients without severe immunosuppression make up a population in which invasive aspergillosis (IA) has been identified as an emergent pathology. Chronic treatment with corticosteroids, chronic obstructive pulmonary disease, and liver cirrhosis are repeatedly identified risk factors. However, due to the non-specificity of the symptoms and signs in the critical patient, and the relative low diagnostic capacity of the complementary tests, the diagnosis of the IA is a challenge for the specialist in critical care medicine. The application of diagnostic algorithms adapted to critical patients, in whom activation will depend on the isolation of Aspergillus in a respiratory specimen, is the most efficient diagnostic methodology in this population. Among the diagnostic approaches, the determination of galactomannan in bronchoalveolar fluid is the most useful diagnostic test. Once the suspicion is established, treatment should be started as soon as possible. Voriconazole, amphotericin B, and isavuconazole are the most effective treatments. Although voriconazole and amphotericin B are the drugs with the most scientific evidence, they are related with adverse effects and pharmacokinetic difficulties. Therefore, isavuconazole, which has shown high efficacy and safety in other populations, is a potential alternative of great interest for critically ill patients.
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Affiliation(s)
- Paula Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - José Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen de la Macarena, Sevilla, España
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Tejerina EE, Abril E, Padilla R, Rodríguez Ruíz C, Ballen A, Frutos-Vivar F, Lorente JÁ, Esteban A. Invasive aspergillosis in critically ill patients: An autopsy study. Mycoses 2019; 62:673-679. [PMID: 31177621 DOI: 10.1111/myc.12927] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/29/2023]
Abstract
Autopsy studies show that IA is among the most commonly missed diagnoses in critically ill patients. And, because of lack of unequivocal diagnostic criteria, a timely diagnosis remains challenging. We investigate the epidemiology of and the clinical risk factors for IA in critically ill patients. We conducted a retrospective, observational study of all consecutive ICU patients with evidence of IA in the postmortem examination. During the period of the study (25 years), 893 postmortem examinations were performed in the ICU. Twenty-five patients (2.8%) were diagnosed with IA in autopsy. Only ten (40%) were classified as IA ante-mortem, based on the initiation of antifungal treatment. The most common comorbid conditions were corticosteroid treatment (n = 14, 56%), chronic obstructive pulmonary disease (COPD) (n = 11, 44%), immunosuppression (n = 6, 24%) and haematological malignancy (n = 5, 20%). Twenty-three patients (92%) had three or more risk factors for IA. Critically ill patients with pulmonary infiltrates, treated with high doses intravenous corticosteroids (even for a short period of time), particularly COPD patients who developed worsening respiratory insufficiency despite appropriate treatment were at the highest risk of IA.
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Affiliation(s)
- Eva E Tejerina
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
| | - Elena Abril
- Intensive Care Unit, Hospital Universitario de Getafe, Getafe, Spain
| | - Rebeca Padilla
- Intensive Care Unit, Hospital Universitario de Getafe, Getafe, Spain
| | | | - Aida Ballen
- Department of Pathology, Hospital Universitario de Getafe, Getafe, Spain
| | - Fernando Frutos-Vivar
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
| | - José Ángel Lorente
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
| | - Andrés Esteban
- Intensive Care Unit, Hospital Universitario de Getafe & Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Getafe, Spain
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8
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Danion F, Rouzaud C, Duréault A, Poirée S, Bougnoux ME, Alanio A, Lanternier F, Lortholary O. Why are so many cases of invasive aspergillosis missed? Med Mycol 2019; 57:S94-S103. [PMID: 30816963 DOI: 10.1093/mmy/myy081] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/10/2018] [Indexed: 12/20/2022] Open
Abstract
Invasive aspergillosis (IA) incidence is increasing in several countries like France, and numerous cases are indeed missed and still only diagnosed at autopsy as evidenced by recently published data. Such missed diagnoses are obviously encountered when appropriate diagnostic tools are not available especially in low resource areas or when biologists have not been trained enough in medical mycology (i.e., microscopic examination and culture in most of those areas). Besides logistical issues, which are indeed critical, IA may not be recognized because clinicians failed to consider that risk factors are evolving with the IA burden now observed among patients with chronic lymphoid malignancies or receiving new biotherapies, with diabetes mellitus or liver cirrhosis and/or acute alcoholic hepatitis, with patients from the intensive care unit (ICU) and among patients with some predisposing primary immune deficiencies now reaching the adult's age. This is also the case for human immunodeficiency virus (HIV)-infected patients who failed to meet the classical definitions of IA. From the radiology perspective, new entities of IA have also emerged which absolutely need to be recognized especially bronchial-based-IA among allogeneic stem cell transplant recipients. Finally, from the laboratory side, contribution and limits of indirect blood biomarkers should be integrated to the clinical life in order not to miss IA cases. To conclude, several diagnostic tools should be combined and a constant dialog between laboratory and clinics is crucial to appropriately diagnose IA.
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Affiliation(s)
- François Danion
- Department of Infectious Diseases and Tropical Medicine, Necker-Pasteur Infectious Diseases Center, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Paris Descartes University, Paris, France.,Aspergillus Unit, Institut Pasteur, Paris, France
| | - Claire Rouzaud
- Department of Infectious Diseases and Tropical Medicine, Necker-Pasteur Infectious Diseases Center, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Paris Descartes University, Paris, France
| | - Amélie Duréault
- Department of Infectious Diseases and Tropical Medicine, Necker-Pasteur Infectious Diseases Center, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Paris Descartes University, Paris, France
| | - Sylvain Poirée
- Department of Radiology, Necker-Enfants Malades University Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Marie-Elisabeth Bougnoux
- Department of Mycology, Necker-Enfants Malades University Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Alexandre Alanio
- National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, Institut Pasteur, Paris, France.,Department of Mycology, Saint-Louis Hospital, AP-HP, Paris, France
| | - Fanny Lanternier
- Department of Infectious Diseases and Tropical Medicine, Necker-Pasteur Infectious Diseases Center, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Paris Descartes University, Paris, France.,National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, Institut Pasteur, Paris, France
| | - Olivier Lortholary
- Department of Infectious Diseases and Tropical Medicine, Necker-Pasteur Infectious Diseases Center, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Paris Descartes University, Paris, France.,National Reference Center for Invasive Mycoses and Antifungals, Molecular Mycology Unit, Institut Pasteur, Paris, France
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9
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Matthaiou DK, Dimopoulos G, Taccone FS, Bulpa P, Van den Abeele AM, Misset B, Meersseman W, Spapen H, Cardoso T, Charles PE, Vogelaers D, Blot S. Elderly versus nonelderly patients with invasive aspergillosis in the ICU: a comparison and risk factor analysis for mortality from the AspICU cohort. Med Mycol 2018; 56:668-678. [PMID: 29228380 DOI: 10.1093/mmy/myx117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 10/17/2017] [Indexed: 12/16/2022] Open
Abstract
Data regarding the epidemiology and diagnosis of invasive aspergillosis in the critically ill population are limited, with data regarding elderly patients (≥75 years old) even scarcer. We aimed to further compare the epidemiology, characteristics and outcome of elderly versus nonelderly critically ill patients with invasive aspergillosis (IA) Prospective, international, multicenter observational study (AspICU) including adult intensive care unit (ICU) patients, with a culture and/or direct examination and/or histopathological sample positive for Aspergillus spp. at any site. We compared clinical characteristics and outcome of IA in ICU patients using two different diagnostic algorithms. Elderly and nonelderly ICU patients with IA differed in a number of characteristics, including comorbidities, clinical features of the disease, mycology testing, and radiological findings. No difference regarding mortality was found. According to the clinical algorithm, elderly patients were more likely to be diagnosed with putative IA. Elderly patients had less diagnostic radiological findings and when these findings were present they were detected late in the disease course. The comparison between elderly survivors and nonsurvivors demonstrated differences in clinical characteristics of the disease, affected sites and supportive therapy needed. All patients who were diagnosed with proven IA died. Increased vigilance combined with active search for mycological laboratory evidence and radiological confirmation are necessary for the timely diagnosis of IA in the elderly patient subset. Although elderly state per se is not a particular risk factor for mortality, a high SOFA score and the decision not to administer antifungal therapy may have an impact on survival of elderly patients.
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Affiliation(s)
- D K Matthaiou
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece
| | - G Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece
| | - F S Taccone
- Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - P Bulpa
- Department of Intensive Care, CHU Dinant-Godinne, Université Catholique de Louvain, Yvoir, Belgium
| | | | - B Misset
- Service de Réanimation Médicale, CHU de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - W Meersseman
- Medical Intensive Care Unit, University Hospital Leuven, Leuven, Belgium
| | - H Spapen
- Intensive Care Department, University Hospital, Vrije Universiteit, Brussels, Belgium
| | - T Cardoso
- Department of Intensive Care (UCIP), Oporto Hospital Centre, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
| | - P E Charles
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. Dijon, Dijon University Hospital, Dijon, France
| | - D Vogelaers
- Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium
| | - S Blot
- Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.,Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
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10
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Abstract
Fungi of the genus Aspergillus are ubiquitously present. Even though humans inhale Aspergillus spores daily under natural conditions, Aspergillus-associated pulmonary diseases only occur under special circumstances. Whether an Aspergillus-associated disease develops and which type of Aspergillus-associated disease develops depends on the constitution of the host. The spectrum of Aspergillus-associated pulmonary diseases ranges from allergic diseases, such as hypersensitivity pneumonitis to allergic infectious diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric granulomatosis (BG) to infectious diseases, such as invasive (IA) or semi-invasive aspergillosis (SIA) and chronic pulmonary aspergillosis (CPA). Identification of Aspergillus spp. from sputum or bronchopulmonary secretions is not sufficient for a definitive diagnosis of Aspergillus-associated infections. The gold standard is the identification of Aspergillus spp. from lung tissue by culture or by histopathological methods; however, in clinical practice the decision to initiate antifungal therapy is more often based on immunological methods, such as the detection of Aspergillus-specific IgG antibodies from peripheral blood or galactomannan antigens from bronchoalveolar lavages. Acute IA or SIA infections have a high mortality and require immediate antifungal therapy. With rare exceptions CPA cannot be cured by medicinal therapy alone; however, active CPA can be brought into remission with antifungal therapy. Eradication of Aspergillus in CPA can as a rule only be successful using a combined antimycotic and surgical intervention.
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Affiliation(s)
- H J F Salzer
- Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Parkallee 35, 23845, Borstel, Deutschland.
- Hamburg - Borstel - Lübeck - Riems DZIF-Standort, Deutsches Zentrum für Infektionsforschung (DZIF), Borstel, Deutschland.
| | - C Lange
- Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Parkallee 35, 23845, Borstel, Deutschland
- Hamburg - Borstel - Lübeck - Riems DZIF-Standort, Deutsches Zentrum für Infektionsforschung (DZIF), Borstel, Deutschland
- International Health and Infectious Diseases, Universität zu Lübeck, Lübeck, Deutschland
- Department of Medicine, Karolinska Institute, Stockholm, Schweden
| | - M Hönigl
- Klinische Abteilung für Pulmonologie, Medizinische Universität Graz, Graz, Österreich
- Sektion für Infektionserkrankungen und Tropenmedizin, Medizinische Universität Graz, Graz, Österreich
- Division of Infectious Diseases, Department of Medicine, University of California - San Diego, San Diego, USA
- CBmed - Center for Biomarker Research in Medicine, Graz, Österreich
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11
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Dabas Y, Mohan A, Xess I. Serum galactomannan antigen as a prognostic and diagnostic marker for invasive aspergillosis in heterogeneous medicine ICU patient population. PLoS One 2018; 13:e0196196. [PMID: 29684057 PMCID: PMC5912734 DOI: 10.1371/journal.pone.0196196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 04/09/2018] [Indexed: 01/19/2023] Open
Abstract
Objective This study was conducted to get a complete clinical and mycological picture of invasive aspergillosis (IA) in respiratory medicine ICU of a tertiary care hospital. Patients From the cohort of 235 patients only one had proven IA. Based on AspICU algorithm, 21 had putative IA (8.9%), 12 were colonised (5.1%). Results Adjusting the confounding factors, significant risk factors for IA were chronic obstructive pulmonary disease (COPD), temperature of ≥38°C, pneumonia and acute respiratory distress syndrome (ARDS). The best predictor of IA was AspICU algorithm (AUC, 1) followed by serum galactomannan antigen (GM) cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.822). For 37% of patients, IA diagnoses was made earlier with serum GM than radiology. There were 70/235 (29.8%) deaths within 30 days of enrolment in the study. Aspergillus culture positivity (34/235, 14.5%) was associated with very high mortality (27/34, 79.4%), (p<0.05). The best predictor of mortality was GM cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.835). Conclusion This study imparts the focus on relatively underestimated Aspergillus infections prevalent in ICUs. The AspICU algorithm was found to be useful over others for IA diagnosis. The prognostic usefulness of serum GM antigen detection test highlighted overlooking the same may not be rewarding for the outcome of IA suspected ICU subpopulation.
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Affiliation(s)
- Yubhisha Dabas
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
- * E-mail:
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12
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Rodríguez-Acelas AL, de Abreu Almeida M, Engelman B, Cañon-Montañez W. Risk factors for health care-associated infection in hospitalized adults: Systematic review and meta-analysis. Am J Infect Control 2017; 45:e149-e156. [PMID: 29031433 DOI: 10.1016/j.ajic.2017.08.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/25/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Health care-associated infections (HAIs) are a public health problem that increase health care costs. This article aimed to systematically review the literature and meta-analyze studies investigating risk factors (RFs) independently associated with HAIs in hospitalized adults. METHODS Electronic databases (MEDLINE, Embase, and LILACS) were searched to identify studies from 2009-2016. Pooled risk ratios (RRs) or odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs) were calculated and compared across the groups. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS Of 867 studies, 65 met the criteria for review, and the data of 18 were summarized in the meta-analysis. The major RFs independently associated with HAIs were diabetes mellitus (RR, 1.76; 95% CI, 1.27-2.44), immunosuppression (RR, 1.24; 95% CI, 1.04-1.47), body temperature (MD, 0.62; 95% CI, 0.41-0.83), surgery time in minutes (MD, 34.53; 95% CI, 22.17-46.89), reoperation (RR, 7.94; 95% CI, 5.49-11.48), cephalosporin exposure (RR, 1.77; 95% CI, 1.30-2.42), days of exposure to central venous catheter (MD, 5.20; 95% CI, 4.91-5.48), intensive care unit (ICU) admission (RR, 3.76; 95% CI, 1.79-7.92), ICU stay in days (MD, 21.30; 95% CI, 19.81-22.79), and mechanical ventilation (OR, 12.95; 95% CI, 6.28-26.73). CONCLUSIONS Identifying RFs that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.
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13
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Liver Abscess in Patients With Leukemia and Prolonged Neutropenia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000478] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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14
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Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures. Int J Antimicrob Agents 2017; 50:529-535. [PMID: 28669830 DOI: 10.1016/j.ijantimicag.2017.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/28/2017] [Accepted: 05/17/2017] [Indexed: 11/20/2022]
Abstract
Invasive pulmonary aspergillosis (IPA) is an increasingly recognised problem in critically ill patients. Little is known about how intensivists react to an Aspergillus-positive respiratory sample or the efficacy of antifungal therapy (AFT). This study aimed to identify drivers of AFT prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. ICU patients with an Aspergillus-positive respiratory sample from the database of a previous observational, multicentre study were analysed. Cases were classified as proven/putative IPA or Aspergillus colonisation. Demographic, microbiological, diagnostic and therapeutic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Patients with putative/proven IPA were more likely to receive AFT than colonised patients (78.7% vs. 25.5%; P <0.001). Patients with host factors for invasive fungal disease were more likely to receive AFT (72.5% vs. 37.4%) as were those with multiorgan failure (SOFA score >7) (68.4% vs. 36.9%) (both P <0.001). Once adjusted for disease severity, initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI 0.89-2.21). Likewise, treatment within 48 h following diagnosis did not change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. IPA in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multiorgan failure.
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15
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Contou D, Dorison M, Rosman J, Schlemmer F, Gibelin A, Foulet F, Botterel F, Carteaux G, Razazi K, Brun-Buisson C, Mekontso Dessap A, de Prost N. Aspergillus-positive lower respiratory tract samples in patients with the acute respiratory distress syndrome: a 10-year retrospective study. Ann Intensive Care 2016; 6:52. [PMID: 27294891 PMCID: PMC4906097 DOI: 10.1186/s13613-016-0156-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/05/2016] [Indexed: 12/24/2022] Open
Abstract
Background The detection of Aspergillus spp. in endotracheal aspirate cultures of mechanically ventilated patients may reflect either colonization or infection. However, little is known about the prevalence and the impact on outcome of respiratory tract sample positive for Aspergillus during the acute respiratory distress syndrome (ARDS). Methods We conducted a monocentric, retrospective study over a 10-year period (January 2006–December 2015) in the ICU of a university hospital. All consecutive adult patients with ARDS were included, and the diagnosis of invasive pulmonary aspergillosis was assessed using a previously validated algorithm. Results In total, 423 ARDS patients were included with 35 patients [8.3 %, 95 % CI (5.4–10.6)] having at least one respiratory tract sample positive for Aspergillus (Aspergillus+ patients) after a median delay of 3 days (1–11) following ICU admission. Comorbidities did not differ between Aspergillus+ and Aspergillus− patients except for more frequent immunosuppression in Aspergillus+ patients (40 vs. 22 %; p = 0.02). There was no difference between Aspergillus− and Aspergillus+ patients regarding in-ICU mortality, ventilator-free days at day 28, and incidence of ventilator-associated pneumonia, but need for renal replacement therapy was higher in Aspergillus+ patients than in others (49 vs. 27 %; p = 0.01). Seventeen [4.0 %, 95 % CI (2.1–5.9)] patients had putative/proven aspergillosis. After adjusting on covariates associated with ICU mortality, putative/proven aspergillosis was associated with in-ICU mortality [aOR = 9.58 (1.97–46.52); p = 0.005], while Aspergillus colonization was not [aOR = 0.64 (0.21–1.99); p = 0.44]. Conclusions Eight percent of ARDS patients had Aspergillus spp.-positive respiratory tract cultures. These had a higher risk of mortality only when categorized as having putative or proven invasive pulmonary aspergillosis.
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Affiliation(s)
- Damien Contou
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Groupe de Recherche CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France
| | - Matthieu Dorison
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Jérémy Rosman
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Frédéric Schlemmer
- Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Antenne de Pneumologie, Assistance Publique-Hôpitaux de Paris, 94010, Créteil, France
| | - Aude Gibelin
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France
| | - Françoise Foulet
- Unité de Mycologie, Département de Biologie-Pathologie, Centre Hospitalier Universitaire Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, 94010, Créteil, France
| | - Françoise Botterel
- Unité de Mycologie, Département de Biologie-Pathologie, Centre Hospitalier Universitaire Henri Mondor, DHU VIC, Assistance Publique-Hôpitaux de Paris, 94010, Créteil, France
| | - Guillaume Carteaux
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Groupe de Recherche CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France
| | - Keyvan Razazi
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Groupe de Recherche CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France
| | - Christian Brun-Buisson
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Groupe de Recherche CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France
| | - Armand Mekontso Dessap
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France.,Groupe de Recherche CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France
| | - Nicolas de Prost
- Groupe Henri Mondor-Albert Chenevier, Centre Hospitalier Universitaire Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, 51, Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil Cedex, France. .,Groupe de Recherche CARMAS, Faculté de Médecine de Créteil, Université Paris Est Créteil, 94010, Créteil, France.
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16
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Die schwere Pneumonie auf der Intensivstation. Med Klin Intensivmed Notfmed 2016; 111:279-89. [DOI: 10.1007/s00063-016-0165-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 10/21/2022]
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17
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Eigl S, Prattes J, Lackner M, Willinger B, Spiess B, Reinwald M, Selitsch B, Meilinger M, Neumeister P, Reischies F, Wölfler A, Raggam RB, Flick H, Eschertzhuber S, Krause R, Buchheidt D, Thornton CR, Lass-Flörl C, Hoenigl M. Multicenter evaluation of a lateral-flow device test for diagnosing invasive pulmonary aspergillosis in ICU patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:178. [PMID: 25927915 PMCID: PMC4421996 DOI: 10.1186/s13054-015-0905-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/30/2015] [Indexed: 12/20/2022]
Abstract
Introduction The incidence of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is increasing, and early diagnosis of the disease and treatment with antifungal drugs is critical for patient survival. Serum biomarker tests for IPA typically give false-negative results in non-neutropenic patients, and galactomannan (GM) detection, the preferred diagnostic test for IPA using bronchoalveolar lavage (BAL), is often not readily available. Novel approaches to IPA detection in ICU patients are needed. In this multicenter study, we evaluated the performance of an Aspergillus lateral-flow device (LFD) test for BAL IPA detection in critically ill patients. Methods A total of 149 BAL samples from 133 ICU patients were included in this semiprospective study. Participating centers were the medical university hospitals of Graz, Vienna and Innsbruck in Austria and the University Hospital of Mannheim, Germany. Fungal infections were classified according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. Results Two patients (four BALs) had proven IPA, fourteen patients (sixteen BALs) had probable IPA, twenty patients (twenty-one BALs) had possible IPA and ninety-seven patients (one hundred eight BALs) did not fulfill IPA criteria. Sensitivity, specificity, negative predictive value, positive predictive value and diagnostic odds ratios for diagnosing proven and probable IPA using LFD tests of BAL were 80%, 81%, 96%, 44% and 17.6, respectively. Fungal BAL culture exhibited a sensitivity of 50% and a specificity of 85%. Conclusion LFD tests of BAL showed promising results for IPA diagnosis in ICU patients. Furthermore, the LFD test can be performed easily and provides rapid results. Therefore, it may be a reliable alternative for IPA diagnosis in ICU patients if GM results are not rapidly available. Trial registration ClinicalTrials.gov NCT02058316. Registered 20 January 2014.
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Affiliation(s)
- Susanne Eigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria. .,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria.
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schoepfstraße 41/III, 6020, Innsbruck, Austria.
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Birgit Spiess
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Mark Reinwald
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Brigitte Selitsch
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Michael Meilinger
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Peter Neumeister
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, 8036, Graz, Austria.
| | - Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria.
| | - Albert Wölfler
- Division of Hematology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 38D, 8036, Graz, Austria.
| | - Reinhard B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
| | - Stephan Eschertzhuber
- Department of Anesthesia and Intensive Care Medicine, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria.
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Theodor-Kutzer-Ufer 1 - 3, 68167, Mannheim, Germany.
| | - Christopher R Thornton
- Biosciences, College of Life and Environmental Sciences, University of Exeter, Stocker Road, EX4 4QD, Exeter, UK.
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Schoepfstraße 41/III, 6020, Innsbruck, Austria.
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A- 8036, Graz, Austria. .,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. .,Division of Infectious Diseases, Department of Medicine, University of California, 200 West Arbor Drive #8208, San Diego, CA, 92103, USA.
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18
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Taccone FS, Van den Abeele AM, Bulpa P, Misset B, Meersseman W, Cardoso T, Paiva JA, Blasco-Navalpotro M, De Laere E, Dimopoulos G, Rello J, Vogelaers D, Blot SI. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:7. [PMID: 25928694 PMCID: PMC4344741 DOI: 10.1186/s13054-014-0722-7] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 12/15/2014] [Indexed: 12/20/2022]
Abstract
Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. Methods An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Results A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incidences of cancer and organ transplantation than those with colonization. Compared with other patients, they were more frequently diagnosed with sepsis on ICU admission and more frequently received vasopressors and renal replacement therapy (RRT) during the ICU stay. Mortality was 38% among colonized patients, 67% in those with putative IA and 79% in those with proven IA (P < 0.001). Independent risk factors for death among patients with IA included older age, history of bone marrow transplantation, and mechanical ventilation, RRT and higher Sequential Organ Failure Assessment score at diagnosis. Conclusions IA among critically ill patients is associated with high mortality. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with Aspergillus spp colonization.
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Affiliation(s)
- Fabio Silvio Taccone
- Department of Intensive Care Erasme Hospital, Free University of Brussels, Route de Lennik 808, 1070, Brussels, Belgium.
| | | | - Pierre Bulpa
- Department of Intensive Care Mont-Godinne University Hospital, Catholic University of Louvain, Avenue G.Thérasse 1, 5530, Yvoir, Belgium.
| | - Benoit Misset
- Department of Intensive Care Foundation Hospital Saint-Joseph, Paris-Descartes University, 185 Rue Raymond Losserand, 75014, Paris, France.
| | - Wouter Meersseman
- Medical Intensive Care Unit, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Teresa Cardoso
- Department of Intensive Care, Santo Antonio Hospital, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - José-Artur Paiva
- Department of Emergency and Intensive Care, Hospital Centre S. Joao and University of Porto Medical School Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Miguel Blasco-Navalpotro
- Department of Intensive Care, University Hospital Severo Ochoa, Avenida de Orellana, s/n 28911, Leganés, Madrid, Spain.
| | - Emmanuel De Laere
- Department of Microbiology, General Hospital Delta, Brugsesteenweg 90, 8800, Roeselare, Belgium.
| | - George Dimopoulos
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Haidari, 124 62, Athens, Greece.
| | - Jordi Rello
- Hospital Universitari Vall d'Hebron, Vall D'Hebron, Institute of Research, CIBERES, Autonomous University of Barcelona, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Dirk Vogelaers
- Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Stijn I Blot
- Department of Internal Medicine Faculty of Medicine & Health Science, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. .,Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Butterfield Street, Herston (Brisbane), 4006, Queensland, Australia.
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