Options and limitations of a surgical approach in patients with invasive pulmonary aspergillosis



Invasive pulmonary aspergillosis (IPA) is a frequent complication in neutropenic patients and associated with a very high mortality. Diagnosis of IPA is usually based on antibiotic resistant fever combined with localised infiltrates on CT scan developing in neutropenic patients. Bronchoalveolar lavage (BAL) has a sensitivity of 43% to detect IPA (12 published studies including 195 patients with histologically proven IPA). Current treatment of IPA consists mainly of amphothericin B. Lung resection (LR) for IPA is rarely considered because of fears of peri-operative bleeding and infection. However, the current literature on LR for IPA (>100 patients) shows an acceptable complication rate: bleeding 7%, air leak 4%, infection 3%, surgery related mortality 1%, 30-day mortality 9% and fungal relapse 10%. Analysis of 27 patients undergoing LR for IPA at our institution revealed: feasibility of LR irrespective of neutrophil- and platelet counts; median duration of operation 120 min; median blood loss 300 ml; immediate extubation in 96%; median ICU-stay 1 day; median duration of chest tube drainage 2 days; secondary stemcell transplantation possible. Medium term survival (12 months) was superior in patients undergoing LR compared to patients with medical treatment alone. Conclusion: lung resection should be considered in selected neutropenic patients with invasive pulmonary aspergillosis.

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11th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 11th (2001)