Invasive Aspergillosis in the Intensive Care Unit

Meersseman, Wouter; Lagrou, Katrien; Maertens, Johan; Wijngaerden, Eric Van

doi:10.1086/518852

Cited by 315 publications

(252 citation statements)

References 71 publications

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“…This rate is in line with data of previous studies (24). Out of 36 cases of our ICU patients who met criteria for Aspergillus infection, 36.1% showed IA.…”

Section: Discussionsupporting

confidence: 93%

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Invasive Aspergillosis in Intensive Care Unit Patients in Iran

Hedayati

Khodavaisy

Amini

et al. 2013

Acta Med. (Hradec Kralove, Czech Repub.)

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Summary:We assessed the intensive care unit (ICU) patients for Invasive aspergillosis (IA) with culture and non-culture based diagnostic methods from Iran. Thirty-six ICU patients with underlying predisposing conditions for IA were enrolled in the study. Sixty eight Bronchoalveolar lavage (BAL) samples were collected by bronchoscope twice a weekly. BAL samples were analyzed by microscopic examination, fungal culture and galactomannan (GM) detection. The Platelia Aspergillus GM EIA was used to quantify GM indices. Samples with a BAL GM index ≥1 were considered as positive for GM. Patients were classified as having probable or possible IA. Out of 36 suspected patients to IA, 36.1% of cases showed IA which were categorized as: 4 cases of possible IA and 9 of probable IA. 76.2% of BAL samples were positive for GM. From 13 patients with IA, 11 (84.6%) had at least one positive BAL GM index. Of these patients, 9 (81.8%) showed probable IA. The main underlying predisposing conditions were neutropenia (53.8%) and COPD (30.8%). Our study has indicated that COPD must be considered as one of the main predisposing condition for occurrence of aspergillosis in ICU patients. Our data have also revealed that GM detection in BAL samples play a significant role to IA diagnosis.

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“…This rate is in line with data of previous studies (24). Out of 36 cases of our ICU patients who met criteria for Aspergillus infection, 36.1% showed IA.…”

Section: Discussionsupporting

confidence: 93%

“…Recent investigations have shown that IA must be considered as an emerging and mortal infectious disease in ICU patients even in the absence of an apparent predisposing immunodeficiency (24,25). In addition, several new publications have also indicated that frequency of IA in the ICU has increased (13,27,30).…”

Section: Introductionmentioning

confidence: 99%

Invasive Aspergillosis in Intensive Care Unit Patients in Iran

Hedayati

Khodavaisy

Amini

et al. 2013

Acta Med. (Hradec Kralove, Czech Repub.)

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“…Ayrıca daha önce yapılan klinik çalışmalar dikkate alınarak, geniş spektrumlu antibiyotik tedavisine yanıt alınamayan, diğer etiyolojik nedenlerle açıkla-namayan pnömoni ve kötüleşen PA akciğer grafi si bulguları da klinik/radyolojik kriterler olarak kabul edildi 4,5,17 . Öncelikle serum GM pozitifl iği ve BAL örneklerindeki kültür pozitifl iği mikolojik kriterler olarak belirlendi.…”

Section: İpa Olgu Tanımlarıunclassified

“…Ancak immün baskılanması olmayan yoğun bakım (YB) hastalarında da invazif pulmoner aspergilloz (İPA) artan sıklıkta bildirilmekte olup insidansı %0.33-19 arasında değişkenlik göstermek-tedir 4 . Nötropenik olmayan YB hastalarında kronik obstrüktif akciğer hastalığının (KOAH) varlığı, steroid kullanımı, çoklu organ yetmezliği, yoğun bakım ve hastane yatış süresin-deki uzama İPA gelişimini kolaylaştırmaktadır [5][6][7] .…”

Section: Introductionunclassified

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

Özger¹,

Hızel²,

Kalkancı³

et al. 2015

Mikrobiyol Bul

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ÖZNötropenik olmayan yoğun bakım (YB) hastaları, invazif pulmoner aspergilloz (İPA) gelişimi için artmış risk taşımaktadır. Bu olgularda, tanı için kullanılabilecek radyolojik ve mikrobiyolojik yöntemlerin (direkt mikroskopi, kültür) duyarlılık ve özgüllükleri oldukça düşüktür. Bu çalışmada, nötropenik olmayan YB hastalarında İPA risk faktörlerinin değerlendirilmesi, galaktomannan (GM) antijen ve Aspergillus nükleik asit tespiti yöntemlerinin, İPA için tanısal değerinin belirlenmesi amaçlanmıştır. Çalışmaya, OcakAralık 2013 tarihleri arasında, göğüs hastalıkları YB ünitesinde invazif mekanik ventilasyon (İMV) ile takip edilen ve bronkoskopi uygulanan 44 hasta (13 kadın, 31 erkek; yaş aralığı: 36-96 yıl) dahil edilmiştir. Geliş Tarihi

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“…[1][2][3][4][5][6][7] Of concern, the incidence of invasive fungal infections has been increasing, along with an epidemiologic shift. 4,[6][7][8] Although Candida spp.…”

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confidence: 99%

Role of Therapeutic Drug Monitoring of Voriconazole in the Treatment of Invasive Fungal Infections

Kuo

Ensom

2009

CJHP

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Background: Voriconazole is a broad-spectrum, second-generation triazole antifungal agent with demonstrated efficacy in the treatment of invasive fungal infections caused by Aspergillus spp. and Candida spp. Given the characteristically poor prognosis of patients with invasive fungal infections and the protracted duration of treatment required, therapeutic monitoring of voriconazole is, in theory, an attractive method to optimize antifungal therapy. Objective:To determine the utility of therapeutic drug monitoring for voriconazole. Methods:A previously published decision-making algorithm was used to assess the currently available literature on therapeutic drug monitoring of voriconazole.Results: Several analytical methods can be used to quantify plasma or serum concentrations of voriconazole. Reasons for therapeutic monitoring of this drug include wide variability both within and between individuals secondary to drug properties, drug-drug interactions, and disease states. Furthermore, voriconazole follows nonlinear pharmacokinetics with saturable hepatic clearance. Another potential factor in favour of therapeutic drug monitoring for voriconazole is genetic polymorphism of CYP2C19, whereby patients who are homozygous for poor metabolism (about 19% of non-Indian Asians) can have 4-fold greater exposure to voriconazole. The concentrations of this drug are also greater in patients with hepatic impairment. Drug-drug interactions with other substrates of CYP2C9, CYP2C19, and CYP3A4 can also alter voriconazole concentrations. However, the correlations between plasma concentrations of voriconazole and its efficacy and toxicity are not well defined. Although lower and upper target thresholds of 0.25-2 mg/L and 4-6 mg/L, respectively, have been suggested, studies to date have not been appropriately designed or powered to reveal any definitive association. Conclusions:Routine therapeutic drug monitoring of voriconazole is not recommended except in certain circumstances, such as lack of response to therapy or evidence of toxicity, in which case selective monitoring of voriconazole concentrations may be of clinical utility. Méthodes : Un algorithme de prise de décision publié a été utilisé pour évaluer la documentation actuellement disponible sur le suivi thérapeutique pharmacologique du voriconazole. Résultats :Plusieurs méthodes analytiques peuvent servir à quantifier les concentrations sériques ou plasmatiques de voriconazole. Les raisons de recourir au suivi thérapeutique pharmacologique de ce médicament sont notamment la grande variabilité intra et interindividuelle attribuable aux propriétés du médicament, aux interactions médicament-médicament et aux affections. De plus, le voriconazole a un comportement pharmacocinétique non linéaire en raison d'une clairance hépatique saturable. Un autre facteur potentiellement en faveur du suivi thérapeutique pharmacologique du voriconazole est le polymorphisme génétique du CYP2C19 qui, chez les patients homozygotes ayant un faible métabolisme (environ 19 % des Asiatiques ...

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Invasive Aspergillosis in the Intensive Care Unit

Cited by 315 publications

References 71 publications

Invasive Aspergillosis in Intensive Care Unit Patients in Iran

Invasive Aspergillosis in Intensive Care Unit Patients in Iran

Evaluation of Risk Factors for Invasive Pulmonary Aspergillosis and Detection of Diagnostic Values of Galactomannan and PCR Methods in Bronchoalveolar Lavage Samples From Non-Neutropenic Intensive Care Unit Patients

Role of Therapeutic Drug Monitoring of Voriconazole in the Treatment of Invasive Fungal Infections

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