Influenza-associated invasive aspergillosis in patients admitted to the intensive care unit in Sweden : a prospective multicentre cohort study
(2024) In Infectious Diseases 56(2). p.110-115- Abstract
BACKGROUND: The purpose of this study was to prospectively investigate the incidence of influenza-associated pulmonary aspergillosis (IAPA) in influenza patients admitted to intensive care units in Sweden.
METHODS: The study included consecutive adult patients with PCR-verified influenza A or B in 12 Swedish intensive care units (ICUs) over four influenza seasons (2019-2023). Patients were screened using serum galactomannan and β-d-glucan tests and fungal culture of a respiratory sample at inclusion and weekly during the ICU stay. Bronchoalveolar lavage was performed if clinically feasible. IAPA was classified according to recently proposed case definitions.
RESULTS: The cohort included 55 patients; 42% were female, and the... (More)
BACKGROUND: The purpose of this study was to prospectively investigate the incidence of influenza-associated pulmonary aspergillosis (IAPA) in influenza patients admitted to intensive care units in Sweden.
METHODS: The study included consecutive adult patients with PCR-verified influenza A or B in 12 Swedish intensive care units (ICUs) over four influenza seasons (2019-2023). Patients were screened using serum galactomannan and β-d-glucan tests and fungal culture of a respiratory sample at inclusion and weekly during the ICU stay. Bronchoalveolar lavage was performed if clinically feasible. IAPA was classified according to recently proposed case definitions.
RESULTS: The cohort included 55 patients; 42% were female, and the median age was 59 (IQR 48-71) years. All patients had at least one galactomannan test, β-d-glucan test and respiratory culture performed. Bronchoalveolar lavage was performed in 24 (44%) of the patients. Five (9%, 95% CI 3.8% - 20.4%) patients were classified as probable IAPA, of which four lacked classical risk factors. The overall ICU mortality was significantly higher among IAPA patients than non-IAPA patients (60% vs 8%, p = 0.01).
CONCLUSIONS: The study represents the first prospective investigation of IAPA incidence. The 9% incidence of IAPA confirms the increased risk of invasive pulmonary aspergillosis among influenza patients admitted to the ICU. Therefore, it appears reasonable to implement a screening protocol for the early diagnosis and treatment of IAPA in influenza patients receiving intensive care.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04172610, registered November 21, 2019.
(Less)
- author
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Infectious Diseases
- volume
- 56
- issue
- 2
- pages
- 110 - 115
- publisher
- Informa Healthcare
- external identifiers
-
- scopus:85175379919
- pmid:37897800
- ISSN
- 2374-4235
- DOI
- 10.1080/23744235.2023.2273381
- language
- English
- LU publication?
- yes
- id
- 5d5767d3-8211-448e-88da-d72e3fe9bb26
- date added to LUP
- 2023-11-02 10:38:57
- date last changed
- 2024-04-12 05:51:49
@article{5d5767d3-8211-448e-88da-d72e3fe9bb26,
abstract = {{<p>BACKGROUND: The purpose of this study was to prospectively investigate the incidence of influenza-associated pulmonary aspergillosis (IAPA) in influenza patients admitted to intensive care units in Sweden.</p><p>METHODS: The study included consecutive adult patients with PCR-verified influenza A or B in 12 Swedish intensive care units (ICUs) over four influenza seasons (2019-2023). Patients were screened using serum galactomannan and β-d-glucan tests and fungal culture of a respiratory sample at inclusion and weekly during the ICU stay. Bronchoalveolar lavage was performed if clinically feasible. IAPA was classified according to recently proposed case definitions.</p><p>RESULTS: The cohort included 55 patients; 42% were female, and the median age was 59 (IQR 48-71) years. All patients had at least one galactomannan test, β-d-glucan test and respiratory culture performed. Bronchoalveolar lavage was performed in 24 (44%) of the patients. Five (9%, 95% CI 3.8% - 20.4%) patients were classified as probable IAPA, of which four lacked classical risk factors. The overall ICU mortality was significantly higher among IAPA patients than non-IAPA patients (60% vs 8%, p = 0.01). </p><p>CONCLUSIONS: The study represents the first prospective investigation of IAPA incidence. The 9% incidence of IAPA confirms the increased risk of invasive pulmonary aspergillosis among influenza patients admitted to the ICU. Therefore, it appears reasonable to implement a screening protocol for the early diagnosis and treatment of IAPA in influenza patients receiving intensive care.</p><p>TRIAL REGISTRATION: ClinicalTrials.gov NCT04172610, registered November 21, 2019.</p>}},
author = {{Krifors, Anders and Blennow, Ola and Påhlman, Lisa I and Gille-Johnson, Patrik and Janols, Helena and Lipcsey, Miklos and Källman, Jan and Tham, Johan and Stjärne Aspelund, Anna and Ljungquist, Oskar and Hammarskjöld, Fredrik and Hällgren, Anita and De Geer, Lina and Lemberg, Marie and Petersson, Johan and Castegren, Markus}},
issn = {{2374-4235}},
language = {{eng}},
number = {{2}},
pages = {{110--115}},
publisher = {{Informa Healthcare}},
series = {{Infectious Diseases}},
title = {{Influenza-associated invasive aspergillosis in patients admitted to the intensive care unit in Sweden : a prospective multicentre cohort study}},
url = {{http://dx.doi.org/10.1080/23744235.2023.2273381}},
doi = {{10.1080/23744235.2023.2273381}},
volume = {{56}},
year = {{2024}},
}