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Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis Full Text
Intensive Care Medicine, 08/30/2011
Burghi G et al. – Hospital mortality remains high in hematology patients requiring mechanical ventilation (MV) with invasive pulmonary aspergillosis (IPA), particularly when concommittant infection occurred. The use of voriconazole improved survival.
Methods- Retrospective study of all hematology patients given MV with IPA between January 1998 and March 2011 at a single center.
- Predictors of 6-month survival or mortality were identified using multivariable analysis.
- The authors studied 67 patients including 49 (73%) with neutropenia, 23 (34%) with long-term steroid therapy, and 14 (21%) with allogeneic bone marrow transplantation.
- Incidence of IPA in the ICU decreased between 1998 and 2011, and mortality in patients receiving mechanical ventilation did not change.
- IPA was confirmed in 6 patients by autopsy and was probable in 61 patients based on host factors, clinical and radiographic features, and either Aspergillus isolation (50 patients) or Aspergillus antigen detection alone (11 patients).
- Concomitant bacterial infections were documented in 24 (36%) patients.
- ICU and 6-month mortality rates were 67 and 82%, respectively.
- Mortality was stable throughout the study period.
- Concomitant bacterial infection was independently associated with higher mortality [HR, 2.1 (1.2–3.8)].
- Mortality was lower in patients given voriconazole [OR, 0.5 (0.3–0.9)].