Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study
Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the...
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| Veröffentlicht in: | The lancet respiratory medicine Jg. 6; H. 10; S. 782 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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England
01.10.2018
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| ISSN: | 2213-2619, 2213-2619 |
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| Abstract | Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.
We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [EORTC/MSG] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).
Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.
Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.
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| AbstractList | Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.BACKGROUNDInvasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [EORTC/MSG] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).METHODSWe did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [EORTC/MSG] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.FINDINGSData were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.INTERPRETATIONInfluenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.None.FUNDINGNone. Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis. We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [EORTC/MSG] host factor) influenza-positive patients (influenza case group) compared with non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group). Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63-10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids. Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis. None. |
| Author | Hodiamont, Casper J Depuydt, Pieter van den Berg, Charlotte H S B Boelens, Jerina Van de Veerdonk, Frank L Juffermans, Nicole P Bergmans, Dennis C J J Vanderbeke, Lore Verweij, Paul E Andrinopoulou, Eleni-Rosalina Spronk, Peter Rijnders, Bart J A Philips, Nele Lagrou, Katrien Schauwvlieghe, Alexander F A D Gommers, Diederik Hoedemaekers, Astrid Vonk, Alieke G Verwijs, Rosanne Van Tienen, Carla Wauters, Joost |
| Author_xml | – sequence: 1 givenname: Alexander F A D surname: Schauwvlieghe fullname: Schauwvlieghe, Alexander F A D organization: Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands – sequence: 2 givenname: Bart J A surname: Rijnders fullname: Rijnders, Bart J A email: b.rijnders@erasmusmc.nl organization: Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands. Electronic address: b.rijnders@erasmusmc.nl – sequence: 3 givenname: Nele surname: Philips fullname: Philips, Nele organization: Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium – sequence: 4 givenname: Rosanne surname: Verwijs fullname: Verwijs, Rosanne organization: Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands – sequence: 5 givenname: Lore surname: Vanderbeke fullname: Vanderbeke, Lore organization: Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium – sequence: 6 givenname: Carla surname: Van Tienen fullname: Van Tienen, Carla organization: Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands – sequence: 7 givenname: Katrien surname: Lagrou fullname: Lagrou, Katrien organization: Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium; Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium – sequence: 8 givenname: Paul E surname: Verweij fullname: Verweij, Paul E organization: Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands; Centre of Expertise in Mycology, Radboudumc/CWZ, Nijmegen, Netherlands – sequence: 9 givenname: Frank L surname: Van de Veerdonk fullname: Van de Veerdonk, Frank L organization: Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands – sequence: 10 givenname: Diederik surname: Gommers fullname: Gommers, Diederik organization: Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands – sequence: 11 givenname: Peter surname: Spronk fullname: Spronk, Peter organization: Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, Netherlands – sequence: 12 givenname: Dennis C J J surname: Bergmans fullname: Bergmans, Dennis C J J organization: Department of Intensive Care, Maastricht University Medical Centre, Maastricht, Netherlands – sequence: 13 givenname: Astrid surname: Hoedemaekers fullname: Hoedemaekers, Astrid organization: Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands – sequence: 14 givenname: Eleni-Rosalina surname: Andrinopoulou fullname: Andrinopoulou, Eleni-Rosalina organization: Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands – sequence: 15 givenname: Charlotte H S B surname: van den Berg fullname: van den Berg, Charlotte H S B organization: Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands; Department of Intensive Care, University Medical Center Groningen, Groningen, Netherlands – sequence: 16 givenname: Nicole P surname: Juffermans fullname: Juffermans, Nicole P organization: Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands – sequence: 17 givenname: Casper J surname: Hodiamont fullname: Hodiamont, Casper J organization: Department of Medical Microbiology, Academic Medical Centre, Amsterdam, Netherlands – sequence: 18 givenname: Alieke G surname: Vonk fullname: Vonk, Alieke G organization: Department of Medical Microbiology, Erasmus MC University Medical Center, Rotterdam, Netherlands – sequence: 19 givenname: Pieter surname: Depuydt fullname: Depuydt, Pieter organization: Department of Intensive Care Medicine, Ghent University, Ghent, Belgium – sequence: 20 givenname: Jerina surname: Boelens fullname: Boelens, Jerina organization: Department of Laboratory Medicine, and Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium – sequence: 21 givenname: Joost surname: Wauters fullname: Wauters, Joost organization: Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30076119$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | Copyright © 2018 Elsevier Ltd. All rights reserved. |
| Copyright_xml | – notice: Copyright © 2018 Elsevier Ltd. All rights reserved. |
| CorporateAuthor | Dutch-Belgian Mycosis study group |
| CorporateAuthor_xml | – name: Dutch-Belgian Mycosis study group |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1016/S2213-2600(18)30274-1 |
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| Snippet | Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial... |
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| SubjectTerms | Aged APACHE Aspergillus Belgium - epidemiology Female Humans Incidence Influenza A virus Influenza B virus Influenza, Human - epidemiology Influenza, Human - microbiology Intensive Care Units - statistics & numerical data Invasive Pulmonary Aspergillosis - epidemiology Invasive Pulmonary Aspergillosis - microbiology Male Middle Aged Netherlands - epidemiology Odds Ratio Patient Admission - statistics & numerical data Retrospective Studies |
| Title | Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study |
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