Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study

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  • Additional Information
    • Affiliation:
      a Department of Internal Medicine, Section of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
      b Department of Viroscience, Erasmus MC University Medical Center, Rotterdam, Netherlands
      c Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands
      d Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands
      e Department of Medical Microbiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
      f Medical Intensive Care Unit, University Hospitals of Leuven, Leuven, Belgium
      g Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals of Leuven, Leuven, Belgium
      h Department of Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
      i Department of Medical Microbiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
      j Department of Intensive Care, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
      k Department of Intensive Care, Academic Medical Centre, Amsterdam, Netherlands
      l Department of Medical Microbiology, Academic Medical Centre, Amsterdam, Netherlands
      m Department of Intensive Care Medicine, Ghent University, Ghent, Belgium
      n Department of Laboratory Medicine, and Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
      o Department of Microbiology and Immunology, KU Leuven University of Leuven, Leuven, Belgium
      p Centre of Expertise in Mycology, Radboudumc/CWZ, Nijmegen, Netherlands
      q Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, Netherlands
      r Department of Intensive Care, Maastricht University Medical Centre, Maastricht, Netherlands
      s Department of Intensive Care, University Medical Center Groningen, Groningen, Netherlands
    • Subject Terms:
    • Abstract:
      Summary Background Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.
    • Abstract:
      Findings Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63–10·26; p<0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.
    • Abstract:
      Interpretation Influenza was identified as an independent risk factor for invasive pulmonary aspergillosis and is associated with high mortality. Future studies should assess whether a faster diagnosis or antifungal prophylaxis could improve the outcome of influenza-associated aspergillosis.
    • Abstract:
      Funding None.
    • ISSN:
      2213-2600
    • Accession Number:
      10.1016/S2213-2600(18)30274-1
    • Accession Number:
      S2213260018302741
    • Copyright:
      © 2018 Elsevier Ltd. All rights reserved.
  • Citations
    • ABNT:
      SCHAUWVLIEGHE, A. F. A. D. et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. The Lancet Respiratory Medicine, [s. l.], v. 6, n. 10, p. 782–792, 2018. DOI 10.1016/S2213-2600(18)30274-1. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S2213260018302741. Acesso em: 26 nov. 2020.
    • AMA:
      Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. The Lancet Respiratory Medicine. 2018;6(10):782-792. doi:10.1016/S2213-2600(18)30274-1
    • APA:
      Schauwvlieghe, A. F. A. D., Rijnders, B. J. A., Philips, N., Verwijs, R., Vanderbeke, L., Van Tienen, C., Lagrou, K., Verweij, P. E., Van de Veerdonk, F. L., Gommers, D., Spronk, P., Bergmans, D. C. J. J., Hoedemaekers, A., Andrinopoulou, E.-R., van den Berg, C. H. S. B., Juffermans, N. P., Hodiamont, C. J., Vonk, A. G., Depuydt, P., … Wauters, J. (2018). Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. The Lancet Respiratory Medicine, 6(10), 782–792. https://doi.org/10.1016/S2213-2600(18)30274-1
    • Chicago/Turabian: Author-Date:
      Schauwvlieghe, Alexander F A D, Bart J A Rijnders, Nele Philips, Rosanne Verwijs, Lore Vanderbeke, Carla Van Tienen, Katrien Lagrou, et al. 2018. “Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit with Severe Influenza: A Retrospective Cohort Study.” The Lancet Respiratory Medicine 6 (10): 782–92. doi:10.1016/S2213-2600(18)30274-1.
    • Harvard:
      Schauwvlieghe, A. F. A. D. et al. (2018) ‘Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study’, The Lancet Respiratory Medicine, 6(10), pp. 782–792. doi: 10.1016/S2213-2600(18)30274-1.
    • Harvard: Australian:
      Schauwvlieghe, AFAD, Rijnders, BJA, Philips, N, Verwijs, R, Vanderbeke, L, Van Tienen, C, Lagrou, K, Verweij, PE, Van de Veerdonk, FL, Gommers, D, Spronk, P, Bergmans, DCJJ, Hoedemaekers, A, Andrinopoulou, E-R, van den Berg, CHSB, Juffermans, NP, Hodiamont, CJ, Vonk, AG, Depuydt, P, Boelens, J & Wauters, J 2018, ‘Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study’, The Lancet Respiratory Medicine, vol. 6, no. 10, pp. 782–792, viewed 26 November 2020, .
    • MLA:
      Schauwvlieghe, Alexander F. A. D., et al. “Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit with Severe Influenza: A Retrospective Cohort Study.” The Lancet Respiratory Medicine, vol. 6, no. 10, Oct. 2018, pp. 782–792. EBSCOhost, doi:10.1016/S2213-2600(18)30274-1.
    • Chicago/Turabian: Humanities:
      Schauwvlieghe, Alexander F A D, Bart J A Rijnders, Nele Philips, Rosanne Verwijs, Lore Vanderbeke, Carla Van Tienen, Katrien Lagrou, et al. “Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit with Severe Influenza: A Retrospective Cohort Study.” The Lancet Respiratory Medicine 6, no. 10 (October 1, 2018): 782–92. doi:10.1016/S2213-2600(18)30274-1.
    • Vancouver/ICMJE:
      Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. The Lancet Respiratory Medicine [Internet]. 2018 Oct 1 [cited 2020 Nov 26];6(10):782–92. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=edselp&AN=S2213260018302741