Incidence of Invasive Aspergillosis among Critically Ill Patients with Positive Culture of Sputum or Aspergillus.

BULPA P., DIVE A., GARRINO M-G., DELOS M., INSTALLE E.

Abstract: 

INTRODUCTION: Invasive aspergillosis (IA) is a well recognised life-threatening infection in immunocompromised patients. However, little is known about its incidence among critically ill pts with positive culture of sputum for aspergillus species. We retrospectively analysed the features and the ICU mortality of such pts. MATERIAL AND METHODS: Since May 1995 until December 1997, all pts admitted in our ICU were screened for Aspergillus in their sputum. Proved (positive tissue biopsy and/or autopsy) or highly probable (repeated isolation of Aspergillus from the sputum with consistent clinical and radiological findings) IA were classified as infection (group 1), the others situations were classified as colonisation (group 11). We reviewed their clinical features and we compared their SAPS 11 score on admission, the presence of a risk factor, their duration of intubation, their treatment and their mortality in ICU. RESULTS: During the investigation period, 63 out of 4968 pts revealed Aspergillus in their sputum. There were 17 pts in group I (12 males; mean age: 60 [26-74]) and 46 pts in group 11 (30 males; mean age: 65 [29-84]). All pts in group I were immunocompromised or treated by corticosteroids but 2, only 24 in group 11. The SAPS 11 score was 53 (16-98) in group I and 44 (20-78) in group 11. Pts in group I stayed 16 days (2-36) in ICU and 14 days (1-76) in group II. Pts in group I were intubated during 12 days compared with 8 days in group II. Pts in group I received Amphotericin B (daily dose: 1- 1. 5mg/kg) sometimes associated with itraconazole; 17 pts in group 11 were treated with itraconazole (n=8) or Amphotericin B (n=9). All pts in group I died in ICU in comparison with 11 in group 11. CONCLUSIONS: The incidence of IA among critically ill pts with positive culture of sputum for Aspergillus is 27 percent. Pts in whom the diagnosis of IA was made present more often an immunodepression and stay longer in ICU. No pts with IA could be extubated and all of them died.
1998

abstract No: 

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Full conference title: 

38th Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 38th