Impact of Invasive Pulmonary Aspergillosis in Critically Ill Surgical Patients with or without Solid Organ Transplantation

Abstract

Background: Critically ill patients, especially those who have undergone solid organ transplantation (SOT), are at risk of invasive pulmonary aspergillosis (IPA). The outcome relevance of adequately treated putative IPA (pIPA) is a matter of debate. The aim of this study is to assess the outcome relevance of pIPA in a cohort of critically ill patients with and without SOT. Methods: Data from 121 surgical critically ill patients with pIPA (n = 30) or non-pIPA (n = 91) were included. Cox regression analysis was used to identify risk factors for mortality and unfavourable outcomes after 28 and 90 days. Results: Mortality rates at 28 days were similar across the whole cohort of patients (pIPA: 31% vs. non-pIPA: 27%) and did not differ in the subgroup of patients after SOT (pIPA: 17% vs. non-pIPA: 22%). A higher Sequential Organ Failure Assessment (SOFA) score and evidence of bacteraemia were identified as risk factors for mortality and unfavourable outcome, whereas pIPA itself was not identified as an independent predictor for poor outcomes. Conclusions: Adequately treated pIPA did not increase the risk of death or an unfavourable outcome in this mixed cohort of critically ill patients with or without SOT, whereas higher disease severity and bacteraemia negatively affected the outcome.

Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis

“…Of the 1067 studies screened, 65 were included in the meta-analysis (Fig. 1 ) [ 29 – 93 ]. Studies were either a retrospective cohort ( n = 46) or case-control ( n = 19) design and were published before October, 2023.…”

“… ICU intensive care unit, ARDS acute respiratory distress syndrome, NR not reported, COPD chronic obstructive pulmonary disease a Prophylaxis was stated as YES even when administrated only by a portion of patients, the following agents were used for antifungal prophylaxis: [ 93 ]: fluconazole/caspofungin; [ 89 ]: itraconazole; [ 47 ]: posaconazole; [ 53 ]: fluconazole/micafungin; [ 38 ]: amphotericin B/voriconazole/itraconazole; [ 30 ]: posaconazole; [ 32 ]: fluconazole, fluconazole/amphotericin B, amphotericin B, voriconazole; [ 64 ]: fluconazole/itraconazole; [ 67 ]: fluconazole/itraconazole; [ 63 ]: itraconazole; [ 70 ]: amphotericin B/fluconazole/itraconazole; [ 71 ]: NA; [ 66 ]: itraconazole; [ 58 ]: posaconazole; [ 69 ]: fluconazole b In the data collection process, the IA type was recorded as mixed when the age of patients was not specifically categorized or stratified based on the IA classification …”

Management of Polypharmacy and Potential Drug–Drug Interactions in Patients with Pulmonary Aspergillosis: A 2-Year Study of a Multidisciplinary Outpatient Clinic

“…Otherwise, chronic pulmonary aspergillosis is observed in immunocompetent individuals with pre-existing pulmonary cavities resulting from tuberculosis, bronchiectasis, sarcoidosis, or cavitary neoplasia. Additionally, allergic bronchopulmonary aspergillosis is seen among patients with underlying cystic fibrosis or asthma [4][5][6][7][8][9][10][11][12]. This disease can also affect elderly individuals with prior or concurrent pulmonary conditions or with increased disease susceptibility (i.e., with pathophysiological lung alterations) [4][5][6].…”