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Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures.

Abstract：

:Invasive pulmonary aspergillosis (IPA) is an increasingly recognised problem in critically ill patients. Little is known about how intensivists react to an Aspergillus-positive respiratory sample or the efficacy of antifungal therapy (AFT). This study aimed to identify drivers of AFT prescription and diagnostic workup in patients with Aspergillus isolation in respiratory specimens as well as the impact of AFT in these patients. ICU patients with an Aspergillus-positive respiratory sample from the database of a previous observational, multicentre study were analysed. Cases were classified as proven/putative IPA or Aspergillus colonisation. Demographic, microbiological, diagnostic and therapeutic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Patients with putative/proven IPA were more likely to receive AFT than colonised patients (78.7% vs. 25.5%; P <0.001). Patients with host factors for invasive fungal disease were more likely to receive AFT (72.5% vs. 37.4%) as were those with multiorgan failure (SOFA score >7) (68.4% vs. 36.9%) (both P <0.001). Once adjusted for disease severity, initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI 0.89-2.21). Likewise, treatment within 48 h following diagnosis did not change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment decisions appear to be based on diagnostic criteria and underlying disease severity at the time of Aspergillus isolation. IPA in this population has a dire prognosis and AFT is not associated with reduced mortality. This may be explained by delayed diagnosis and an often inevitable death due to advanced multiorgan failure.

journal_name

Int J Antimicrob Agents

journal_title

International journal of antimicrobial agents

authors

Paiva JA,Mergulhão P,Gomes A,Taccone FS,Van den Abeele AM,Bulpa P,Misset B,Meersseman W,Dimopoulos G,Rello J,Vogelaers D,Blot S

doi

10.1016/j.ijantimicag.2017.05.017

subject

Has Abstract

pub_date

2017-10-01 00:00:00

pages

529-535

issue

eissn

0924-8579

issn

1872-7913

pii

S0924-8579(17)30234-0

journal_volume

pub_type

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Drivers and impact of antifungal therapy in critically ill patients with Aspergillus-positive respiratory tract cultures.