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

Claverias, L.; Daniel, X.; Martín-Loeches, I.; Vidal-Cortez, P.; Gómez-Bertomeu, F.; Trefler, S.; Zaragoza, R.; Borges-Sa, M.; Reyes, L.F.; Quindós, G.; Peman, J.; Bodí, M.; Díaz, E.; Sarvisé, C.; Pico, E.; Papiol, E.; Solé-Violan, J.; Marín-Corral, J.; Guardiola, J.J.; Rodríguez, A.

doi:10.1016/j.medine.2021.12.013

ISSN: 2173-5727

Medicina Intensiva is the journal of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICIUC), and has become the reference publication in Spanish in its field. Medicina Intensiva mainly publishes Original Articles, Reviews, Clinical Notes, Images in Intensive Medicine, and Information relevant to the specialty. All works go through a rigorous selection process.

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2.799

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2.4

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0.333

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SNIP 2021

0.856

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Vol. 46. Issue 8.

Pages 426-435 (August 2022)

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Vol. 46. Issue 8.

Pages 426-435 (August 2022)

Original

DOI: 10.1016/j.medine.2021.12.013

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

Impacto del aislamiento de Aspergillus spp. en las primeras 24h de ingreso en pacientes críticos con neumonía grave por el virus influenza

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L. Claveriasa,b,

Corresponding author

lauraclaverias@gmail.com

Corresponding author.

, X. Daniela, I. Martín-Loechesc, P. Vidal-Cortezd, F. Gómez-Bertomeue, S. Treflera,b, R. Zaragozaf, M. Borges-Sag, L.F. Reyesh,i, G. Quindósj, J. Pemank, M. Bodíl, E. Díazm, C. Sarvisée, E. Picoe, E. Papioln, J. Solé-Violano, J. Marín-Corralp, J.J. Guardiolaq, A. Rodríguezl, on behalf of the GETGAG/SEMICYUC Working Group 1

a Critical Care Department, Hospital Universitari Joan XXIII, Tarragona, Spain

b Institut d’Investigació Sanitaria Pere Virgili, Reus, Spain

c Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St James's University Hospital, Dublin, Ireland

d Critical Care Department, Complejo Hospitalario Universitario Ourense, Spain

e Microbiology Department, Hospital Universitari Joan XXIII, Tarragona, Spain

f Critical Care Department, Hospital Dr Peset, Valencia, Spain

g Multidisciplinar Sepsis Unit, Critical Care Department, Hospital Son Llàtzer, Palma de Mallorca, Spain

h Infectious Diseases Department, Universidad de La Sabana, Chía, Colombia

i Critical Care Department, Clinica Universidad de La Sabana, Chía, Colombia

j Department of Immunology, Microbiology and Parasitology, Faculty of Medicine and Nursery, University of the Basque Country (UPV/EHU), Bilbao, Spain

k Institute of Sanitary Investigation La Fe, Hospital Universitari I Politècnic La Fe, Valencia, Spain

l Critical Care Department URV/IISPV/CIBERES, Hospital Universitari Joan XXIII Tarragona, Spain

m Critical Care Department, Hospital Parc Taulí, Sabadell, Spain

n Critical Care Department, Hospital Valle Hebrón, Barcelona, Spain

o Critical Care Department Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, Spain

p Critical Care Department, Hospital del Mar, Barcelona, Spain

q Department of Pulmonary, Critical Care and Sleep Medicine, University of Louisville, USA

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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.

Keywords:

Influenza

IAPA

Aspergillosis

Critically ill

Immunosupression

Resumen

Objetivo

Determinar la incidencia y el impacto sobre la mortalidad del aislamiento de Aspergillus spp. (AI) en paciente críticos con neumonía por influenza en las primeras 24h de ingreso.

Diseño

Análisis secundario de estudio de cohortes observacional y prospectivo.

Ámbito

Unidades de cuidados intensivos (UCI) participantes de forma voluntaria en el registro español de neumonía por influenza grave, desde junio de 2009 hasta junio de 2019.

Pacientes

Pacientes consecutivos con diagnóstico de neumonía grave por influenza, confirmado por prueba de reacción en cadena de la polimerasa.

Intervenciones

Ninguna.

Variables principales

Incidencia de AI. Variables demográficas, comorbilidades, necesidad de ventilación mecánica y presencia de shock al ingreso. APACHE II.

Resultados

Se analizaron 3.702 pacientes. La incidencia de AI fue del 1,13% (n=42). Las neoplasias hematológicas (OR: 4,39; IC 95%: 1,92-10,04); VIH (OR: 3,83; IC 95%: 1,08-13,63) y otras situaciones de inmunosupresión (OR: 4,87; IC 95%: 1,99-11,87) fueron variables que se asociaron de forma independiente con AI. El árbol de decisión de CHAID mostró que la variable neoplasias hematológicas era la más relacionada con la variable Aspergillus spp. con una incidencia del 3,3%. Neoplasias hematológicas (OR: 2,62; IC 95%: 1,95-3,51), inmunosupresión (OR: 2,05; IC 95%: 1,46-2,88) y AI (OR: 3,24; IC 95%: 1,60-6,53) se asociaron de forma independiente con mayor mortalidad en la UCI.

Conclusiones

El tratamiento antifúngico empírico en nuestra población estaría justificado en los pacientes con inmunosupresión. En los pacientes con riesgo moderado-grave, la búsqueda activa de Aspergillus spp. debería implementarse.

Palabras clave:

Influenza

IAPA

Aspergilosis

Enfermo crítico

Inmunosupresión

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