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. 2020 Oct;39(10):1915-1923.
doi: 10.1007/s10096-020-03923-7. Epub 2020 Jun 3.

Influenza-associated aspergillosis in critically-ill patients-a retrospective bicentric cohort study

Frederike Waldeck  1 , Filippo Boroli  2 , Noémie Suh  2 , Pedro David Wendel Garcia  3 , Domenica Flury  1 , Julia Notter  1 , Anne Iten  4 , Laurent Kaiser  5 , Jacques Schrenzel  5 , Katia Boggian  1 , Marco Maggiorini  3 , Jérôme Pugin  2 , Gian-Reto Kleger  6 , Werner Christian Albrich  7
Affiliations

Influenza-associated aspergillosis in critically-ill patients-a retrospective bicentric cohort study

Frederike Waldeck et al. Eur J Clin Microbiol Infect Dis. 2020 Oct.

Abstract

Influenza was recently reported as a risk factor for invasive aspergillosis (IA). We aimed to describe prognostic factors for influenza-associated IA (IAA) and poor outcome and mortality in critically ill patients in Switzerland. All adults with confirmed influenza admitted to the ICU at two Swiss tertiary care centres during the 2017/2018 influenza season were retrospectively evaluated. IAA was defined by clinical, mycological and radiological criteria: a positive galactomannan in bronchoalveolar lavage or histopathological or cultural evidence in respiratory specimens of Aspergillus spp., any radiological infiltrate and a compatible clinical presentation. Poor outcome was defined as a composite of in-hospital mortality, ICU length of stay (LOS), invasive ventilation for > 7 days or extracorporeal membrane oxygenation. Of 81 patients with influenza in the ICU, 9 (11%) were diagnosed with IAA. All patients with IAA had poor outcome compared to 26 (36%) patients without IAA (p < 0.001). Median ICU-LOS and mortality were 17 vs. 3 days (p < 0.01) and 3/9 (33%) vs. 13/72 (18%; p = 0.37) in patients with vs. without IAA, respectively. Patients with IAA had significantly longer durations of antibiotic therapy, vasoactive support and mechanical ventilation. Aspergillus was the most common respiratory co-pathogen (9/40, 22%) followed by classical bacterial co-pathogens. IAA was not associated with classical risk factors. Aspergillus is a common superinfection in critically ill influenza patients associated with poor outcome and longer duration of organ supportive therapies. Given the absence of classical risk factors for aspergillosis, greater awareness is necessary, particularly in those requiring organ supportive therapies.

Keywords: Influenza; Influenza-associated aspergillosis; Intensive care unit; Invasive aspergillosis; Pneumonia.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Duration of antibiotic use, organ supportive therapies and LOS - length of stay
Fig. 2
Fig. 2
Kaplan Meier curve on the probability of ICU stay in IAA and non-IAA patients
Fig. 3
Fig. 3
Number of isolated pathogens in patients with influenza
See this image and copyright information in PMC

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