Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia.

Fecha de publicación: 01/01/2022

Autores de IIS La Fe

Ignacio Martin Loheches

Autor
Javier Pemán García

Autor

Participantes ajenos a IIS La Fe

Claverias L
Daniel X
Vidal-Cortez P
Gómez-Bertomeu F
Trefler S
Zaragoza R
Borges-Sa M
Reyes LF
Quindós G
Bodí M
Díaz E
Sarvisé C
Pico E
Papiol E
Solé-Violan J
Marín-Corral J
Guardiola JJ
Rodríguez A
GETGAG/SEMICYUC Working Group

Grupos

Infección Grave

Investigador Principal

María Ángeles Tormo Mas

Abstract

OBJECTIVE: To determine the incidence and impact of Aspergillus spp. isolation (AI) on ICU mortality in critically ill patients with severe influenza pneumonia during the first 24h of admission. DESIGN: Secondary analysis of an observational and prospective cohort study. SETTING: ICUs voluntary participating in the Spanish severe Influenza pneumonia registry, between June 2009 and June 2019. PATIENTS: Consecutive patients admitted to the ICU with diagnosis of severe influenza pneumonia, confirmed by real-time polymerase chain reaction. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Incidence of AI in respiratory samples. Demographic variables, comorbidities, need for mechanical ventilation and the presence of shock according at admission. Acute Physiology and Chronic Health Evaluation II (APACHE II) scale calculated on ICU admission. RESULTS: 3702 patients were analyzed in this study. AI incidence was 1.13% (n=42). Hematological malignancies (OR 4.39, 95% CI 1.92-10.04); HIV (OR 3.83, 95% CI 1.08-13.63), and other immunosuppression situations (OR 4.87, 95% CI 1.99-11.87) were factors independently associated with the presence of Aspergillus spp. The automatic CHAID decision tree showed that hematologic disease with an incidence of 3.3% was the most closely AI related variable. Hematological disease (OR 2.62 95% CI 1.95-3.51), immunosuppression (OR 2.05 95% CI 1.46-2.88) and AI (OR 3.24, 95% CI 1.60-6.53) were variables independently associated with ICU mortality. CONCLUSIONS: Empirical antifungal treatment in our population may only be justified in immunocompromised patients. In moderate-high risk cases, active search for Aspergillus spp. should be implemented.

Datos de la publicación

ISSN/ISSNe:: 2173-5727, 2173-5727
Tipo:: Article
Páginas:: 426-435
DOI:: 10.1016/j.medine.2021.12.013

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Filiaciones

Claverias L:: Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain

Institut d'Investigació Sanitaria Pere Virgili, Reus, Spain
Daniel X:: Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain
Martín-Loeches I:: Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St James's University Hospital, Dublin, Ireland
Vidal-Cortez P:: Critical Care Department, Complejo Hospitalario Universitario Ourense, Spain
Gómez-Bertomeu F:: Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
Trefler S:: Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain

Institut d'Investigació Sanitaria Pere Virgili, Reus, Spain
Zaragoza R:: Critical Care Department, Hospital Dr Peset, Valencia, Spain
Borges-Sa M:: Multidisciplinar Sepsis Unit, Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
Reyes LF:: Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia

Critical Care Department, Clinica Universidad de La Sabana, Chía, Colombia
Quindós G:: Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain
Peman J:: Institute of Sanitary Investigation La Fe, Hospital Universitari I Politècnic La Fe, Valencia, Spain
Bodí M:: Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain
Díaz E:: Critical Care Department, Hospital Parc Taulí, Sabadell, Spain
Sarvisé C:: Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
Pico E:: Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
Papiol E:: Critical Care Department, Hospital Valle Hebrón, Barcelona, Spain
Solé-Violan J:: Critical Care Department Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain
Marín-Corral J:: Critical Care Department, Hospital del Mar, Barcelona, Spain
Guardiola JJ:: Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, USA
Rodríguez A:: Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain