Article (Scientific journals)
Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures.
Paiva, J. A.; Mergulhao, P.; Gomes, A. et al.
2017In International Journal of Antimicrobial Agents, 50 (4), p. 529-535
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Keywords :
Aged; Amphotericin B/therapeutic use; Antifungal Agents/therapeutic use; Aspergillus/drug effects/isolation & purification; Clinical Decision-Making; Critical Illness; Delayed Diagnosis/mortality; Drug Therapy, Combination; Echinocandins/therapeutic use; Female; Fungal Proteins/therapeutic use; Humans; Intensive Care Units; Invasive Pulmonary Aspergillosis/diagnosis/drug therapy/microbiology/mortality; Male; Middle Aged; Prognosis; Respiratory System/microbiology; Treatment Outcome; Voriconazole/therapeutic use; Delayed diagnosis; Invasive pulmonary aspergillosis; Therapy
Abstract :
[en] Invasive pulmonary aspergillosis (IPA) is an increasingly recognised problem in critically ill patients. Little is known about how intensivists react to an Aspergillus-positive respiratory sample or the efficacy of antifungal therapy (AFT). This study aimed to identify drivers of AFT prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. ICU patients with an Aspergillus-positive respiratory sample from the database of a previous observational, multicentre study were analysed. Cases were classified as proven/putative IPA or Aspergillus colonisation. Demographic, microbiological, diagnostic and therapeutic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Patients with putative/proven IPA were more likely to receive AFT than colonised patients (78.7% vs. 25.5%; P <0.001). Patients with host factors for invasive fungal disease were more likely to receive AFT (72.5% vs. 37.4%) as were those with multiorgan failure (SOFA score >7) (68.4% vs. 36.9%) (both P <0.001). Once adjusted for disease severity, initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI 0.89-2.21). Likewise, treatment within 48 h following diagnosis did not change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. IPA in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multiorgan failure.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Paiva, J. A.
Mergulhao, P.
Gomes, A.
Taccone, F. S.
Van den Abeele, A.-M.
Bulpa, P.
Misset, Benoît ;  Université de Liège - CHU > Soins Intensifs
Meersseman, W.
Dimopoulos, G.
Rello, J.
Vogelaers, D.
Blot, S.
Language :
English
Title :
Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures.
Publication date :
2017
Journal title :
International Journal of Antimicrobial Agents
ISSN :
0924-8579
eISSN :
1872-7913
Publisher :
Elsevier, Amsterdam, Netherlands
Volume :
50
Issue :
4
Pages :
529-535
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Copyright (c) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
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since 21 February 2020

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