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Massart N, Plainfosse E, Benameur Y, Dupin C, Legall F, Cady A, Gourmelin F, Legay F, Barbarot N, Magalhaes E, Fillatre P, Frerou A, Reizine F. Prediction of pulmonary aspergillosis in patients with ventilator-associated pneumonia. Ann Intensive Care 2023; 13:109. [PMID: 37935890 PMCID: PMC10630265 DOI: 10.1186/s13613-023-01199-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/30/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Predictors of ICU-acquired pulmonary aspergillosis (IPA) are not well-established in critically ill patients with ventilator-associated pneumonia (VAP), making IPA commonly misdiagnosed and anti-fungal therapy delayed. We aimed to develop a clinical score for prediction of IPA among patients with VAP. METHODS Mechanically ventilated patients who developed VAP in 4 ICUs in Bretagne, Western France, were included. The score was constructed in a learning cohort, based on predictors of IPA in logistic regression model, and validated in a validation cohort. RESULTS Among 1636 mechanically ventilated patients, 215 developed VAP but only 39 developed IPA (4 possible and 35 probable/putative) (18%). Most cases (31/39) were documented through a positive broncho-alveolar sample culture. Independent predictors of IPA were immunodepression (including onco-hematological disorder, immunomodulatory treatment, solid organ transplant, neutropenia < 0.5G/L and high-dose steroids ≥ 1 mg/kg/day of prednisolone equivalent) (p = 0.001; score = 1 point) and lymphocyte count at admission < 0.8 G/L (p = 0.019; score = 1 point). Operational values of the predictive score in the learning/validation cohort were 50%/52% sensitivity and 90%/87% specificity, respectively, for high PiPa score (score = 2) and 94%/91% sensitivity and 44%/46% specificity, respectively, for moderate PiPa score (score = 1). Finally, the AUC for the prediction of IPA was 0.783 in the learning cohort and 0.770 in the validation cohort. CONCLUSIONS We evaluated a clinical score with good predictive value which may help to predict IPA in patient with VAP. External validation will be needed to confirm our preliminary findings.
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Affiliation(s)
- Nicolas Massart
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France.
| | - Emma Plainfosse
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
- Service d'Anesthésie et de Réanimation Chirurgicale, CHU de Rennes, 2, rue Henry le Guilloux, 35000, Rennes, France
| | - Yanis Benameur
- Service de Réanimation, CH de QUIMPER, 14Bis Avenue Yves Thépot, 29107, Quimper, France
| | - Clarisse Dupin
- Service de Microbiologie, CH de St BRIEUC, 10, rue marcel Proust, 22000, Saint-Brieuc, France
| | - Florence Legall
- Service de Microbiologie, CH de QUIMPER, 14bis Avenue Yves Thépot, 29107, Quimper, France
| | - Anne Cady
- Laboratoire de Biologie Médicale, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
| | - Frederic Gourmelin
- Service de Réanimation, CH de Saint-Malo, 1 rue de la marne, 35400, Saint-Malo, France
| | - François Legay
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Nicolas Barbarot
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Eric Magalhaes
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Pierre Fillatre
- Service de Réanimation, CH de St BRIEUC, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Aurélien Frerou
- Service de Réanimation, CH de Saint-Malo, 1 rue de la marne, 35400, Saint-Malo, France
| | - Florian Reizine
- Service de Réanimation, CH de Vannes, 20, bd Maurice Guillaudot, 56000, Vannes, France
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Massart N, Plainfosse E, Julien G, Magalhaes E, Fillâtre P. Dichotomy between ventilator-associated pneumonia/-tracheobronchitis: did you ask the lung its opinion? Intensive Care Med 2023; 49:1031-1033. [PMID: 37256342 PMCID: PMC10231292 DOI: 10.1007/s00134-023-07105-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Nicolas Massart
- Intensive-Care Unit, Centre Hospitalier Yves Le Foll, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France.
| | - Emma Plainfosse
- Intensive-Care Unit, Centre Hospitalier Yves Le Foll, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
- Department of Anesthesia and Critical Care, Rennes University Hospital, Rennes, France
| | - Gauthier Julien
- Intensive-Care Unit, Centre Hospitalier Yves Le Foll, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Eric Magalhaes
- Intensive-Care Unit, Centre Hospitalier Yves Le Foll, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
| | - Pierre Fillâtre
- Intensive-Care Unit, Centre Hospitalier Yves Le Foll, 10, Rue Marcel Proust, 22000, Saint-Brieuc, France
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