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. 2016 Dec;6(1):52.
doi: 10.1186/s13613-016-0156-2. Epub 2016 Jun 13.

Aspergillus-positive lower respiratory tract samples in patients with the acute respiratory distress syndrome: a 10-year retrospective study

Damien Contou  1   2 , Matthieu Dorison  1 , Jérémy Rosman  1 , Frédéric Schlemmer  3 , Aude Gibelin  1 , Françoise Foulet  4 , Françoise Botterel  4 , Guillaume Carteaux  1   2 , Keyvan Razazi  1   2 , Christian Brun-Buisson  1   2 , Armand Mekontso Dessap  1   2 , Nicolas de Prost  5   6
Affiliations

Aspergillus-positive lower respiratory tract samples in patients with the acute respiratory distress syndrome: a 10-year retrospective study

Damien Contou et al. Ann Intensive Care. 2016 Dec.

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.

Keywords: Acute respiratory distress syndrome; Aspergillus; Immunosuppression; Invasive pulmonary aspergillosis.

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Figures

Fig. 1
Fig. 1
Flowchart of patients with the acute respiratory distress syndrome (ARDS) included in the study. Eight percent of patients (n = 35) had a respiratory tract culture positive for Aspergillus spp., including both immunosuppressed (n = 17) and non-immunosuppressed (n = 18) patients. The diagnostic probability of invasive pulmonary aspergillosis was assessed using the algorithm of Blot et al. [16]
Fig. 2
Fig. 2
Chest CT scan images in patients with ARDS and one or more respiratory tract culture positive for Aspergillus spp., categorized as having putative invasive pulmonary aspergillosis (IPA) or Aspergillus colonization [16]. CT scan slices depicted a ARDS-typical bilateral basal consolidations, together with ground-glass opacities (left panel) and left anterior pneumothorax (right panel) in a patient categorized as having putative IPA; b right upper lobe cavitation (left panel), together with nodular lesions (right panel) in a patient with necrotizing group A Streptococcus, categorized as having Aspergillus respiratory tract colonization; and c nodular lesions with ground-glass opacities (left panel) and alveolar consolidations (right panel) in a patient categorized as having putative IPA
See this image and copyright information in PMC

References

    1. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46:1813–1821. doi: 10.1086/588660. - DOI - PMC - PubMed
    1. Koulenti D, Garnacho-Montero J, Blot S. Approach to invasive pulmonary aspergillosis in critically ill patients. Curr Opin Infect Dis. 2014;27:174–183. doi: 10.1097/QCO.0000000000000043. - DOI - PubMed
    1. Dimopoulos G, Piagnerelli M, Berre J, Eddafali B, Salmon I, Vincent JL. Disseminated aspergillosis in intensive care unit patients: an autopsy study. J Chemother. 2003;15:71–75. doi: 10.1179/joc.2003.15.1.71. - DOI - PubMed
    1. Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E. Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med. 2004;170:621–625. doi: 10.1164/rccm.200401-093OC. - DOI - PubMed
    1. Wauters J, Baar I, Meersseman P, Meersseman W, Dams K, De Paep R, Lagrou K, Wilmer A, Jorens P, Hermans G. Invasive pulmonary aspergillosis is a frequent complication of critically ill H1N1 patients: a retrospective study. Intensive Care Med. 2012;38:1761–1768. doi: 10.1007/s00134-012-2673-2. - DOI - PMC - PubMed

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