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Observational Study
. 2018 Jul;37(7):1251-1257.
doi: 10.1007/s10096-018-3241-7. Epub 2018 Apr 6.

Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation

I Rodriguez-Goncer  1 , S Thomas  2 , P Foden  3 , M D Richardson  4   5 , A Ashworth  6 , J Barker  6 , C G Geraghty  7 , E G Muldoon  8   9   10 , T W Felton  11   12   13
Affiliations
Observational Study

Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation

I Rodriguez-Goncer et al. Eur J Clin Microbiol Infect Dis. 2018 Jul.

Abstract

To identify the incidence, risk factors and impact on long-term survival of invasive pulmonary aspergillosis (IPA) and Aspergillus colonisation in patients receiving vv-extracorporeal membrane oxygenation (ECMO). A retrospective evaluation was performed of patients receiving vv-ECMO at a tertiary hospital in Manchester (UK) between January 2012 and December 2016. Data collected included epidemiological data, microbiological cultures, radiographic findings and outcomes. Cases were classified as proven IPA, putative IPA or Aspergillus colonisation according to a validated clinical algorithm. One hundred thirty-four patients were supported with vv-ECMO, median age of 45.5 years (range 16.4-73.4). Ten (7%) patients had putative IPA and nine (7%) had Aspergillus colonisation. Half of the patients with putative IPA lacked classical host risk factors for IPA. The median number of days on ECMO prior to Aspergillus isolation was 5 days. Immunosuppression and influenza A infection were significantly associated with developing IPA in a logistic regression model. Cox regression model demonstrates a three times greater hazard of death associated with IPA. Overall 6-month mortality rate was 38%. Patients with putative IPA and colonised patients had a 6-month mortality rate of 80 and 11%, respectively. Immunosuppression and influenza A infection are independent risk factors for IPA. IPA, but not Aspergillus colonisation, is associated with high long-term mortality in patients supported with vv-ECMO.

Keywords: Aspergillus fumigatus; ECMO; Galactomannan; Outcome; Voriconazole.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart and mortality in all groups of patients included in the study
Fig. 2
Fig. 2
Kaplan-Meier plots showing long-term outcome of patients who received vv-ECMO with putative IPA and Aspergillus colonisation and patients with no evidence of Aspergillus infection during their admission
Fig. 3
Fig. 3
BAL GM mean optical indexes (ODI) measured in patients with putative IPA and Aspergillus colonisation and patients with no evidence of Aspergillus in their airways
See this image and copyright information in PMC

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