Usefulness of ICU criteria for diagnosis of invasive pulmonary aspergillosis in nonhematologic critically ill patients

2019 ◽  
Vol 58 (3) ◽  
pp. 275-281
Author(s):  
Song-I Lee ◽  
Heungsup Sung ◽  
Sang-Bum Hong ◽  
Chae-Man Lim ◽  
Younsuck Koh ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Hematologic Malignancy ◽  
Invasive Pulmonary Aspergillosis ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Pulmonary Aspergillosis ◽  
Treatment Groups ◽  
Significant Difference ◽  
Criteria For Diagnosis

Abstract Invasive pulmonary aspergillosis (IPA) is a life-threatening disease in the intensive care unit (ICU). The ICU criteria were proposed to diagnose IPA in critically ill patients. This study aims to evaluate the usefulness of ICU criteria for diagnosis and treatment of IPA in nonhematologic patients in the ICU. We retrospectively reviewed 103 ICU patients with positive galactomannan test in blood and respiratory tract from January 1, 2016, to May 31, 2017. We excluded patients with hematologic malignancy. We divided the treatment and non-treatment groups according to the IPA treatment. We compared the baseline characteristics and outcomes between two groups and the agreement with ICU criteria. There were 49 patients in treatment groups and 54 patients in non-treatment groups. There were more cases of solid organ transplantation (P = .003), immunosuppressive therapy (P < .001) and bacterial viral coinfection (P = .048) in the treatment group compared to nontreatment group. There was no statistically significant difference in mortality, the use of ventilator, and septic shock between the two groups. The agreement rate between the putative group and treatment was low (59.2%). There was no statistically significant difference in outcome between the putative and colonization groups according to the ICU criteria in each group. The treatment of IPA based on the symptom, radiologic finding and galactomannan test did not showed the better outcome. Also, the treatment based on the ICU criteria didn’t show the difference of outcome. The new criteria for diagnosis of IPA in critically ill patients are needed.

Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 41 (01) ◽  
pp. 080-098 ◽  
Author(s):  
Marie-Pierre Ledoux ◽  
Blandine Guffroy ◽  
Yasmine Nivoix ◽  
Célestine Simand ◽  
Raoul Herbrecht
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Immunosuppressive Agents ◽  
Invasive Pulmonary Aspergillosis ◽  
Solid Organ ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem

AbstractInvasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

scholarly journals Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19

2020 ◽  
Vol 8 (6) ◽  
pp. e48-e49 ◽  
Author(s):  
Alexandre Alanio ◽  
Sarah Dellière ◽  
Sofiane Fodil ◽  
Stéphane Bretagne ◽  
Bruno Mégarbane
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals A Prospective Pilot Trial to Assess the Efficacy of Argatroban (Argatra®) in Critically Ill Patients with Heparin Resistance †

2020 ◽  
Vol 9 (4) ◽  
pp. 963 ◽  
Author(s):  
Mirjam Bachler ◽  
Tobias Hell ◽  
Johannes Bösch ◽  
Benedikt Treml ◽  
Bettina Schenk ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Success ◽  
Pilot Trial ◽  
Treatment Phase ◽  
Thromboembolic Complications ◽  
Treatment Groups ◽  
Heparin Resistance ◽  
Significant Difference ◽  
Prophylactic Anticoagulation

The current study aims to evaluate whether prophylactic anticoagulation using argatroban or an increased dose of unfractionated heparin (UFH) is effective in achieving the targeted activated partial thromboplastin time (aPTT) of more than 45 s in critically ill heparin-resistant (HR) patients. Patients were randomized either to continue receiving an increased dose of UFH, or to be treated with argatroban. The endpoints were defined as achieving an aPTT target of more than 45 s at 7 h and 24 h. This clinical trial was registered on clinicaltrials.gov (NCT01734252) and on EudraCT (2012-000487-23). A total of 42 patients, 20 patients in the heparin and 22 in the argatroban group, were included. Of the patients with continued heparin treatment 55% achieved the target aPTT at 7 h, while only 40% of this group maintained the target aPTT after 24 h. Of the argatroban group 59% reached the target aPTT at 7 h, while at 24 h 86% of these patients maintained the targeted aPTT. Treatment success at 7 h did not differ between the groups (p = 0.1000), whereas at 24 h argatroban showed significantly greater efficacy (p = 0.0021) than did heparin. Argatroban also worked better in maintaining adequate anticoagulation in the further course of the study. There was no significant difference in the occurrence of bleeding or thromboembolic complications between the treatment groups. In the case of heparin-resistant critically ill patients, argatroban showed greater efficacy than did an increased dose of heparin in achieving adequate anticoagulation at 24 h and in maintaining the targeted aPTT goal throughout the treatment phase.

scholarly journals Management of invasive pulmonary aspergillosis in non-neutropenic critically ill patients

2007 ◽  
Vol 33 (10) ◽  
pp. 1694-1703 ◽  
Author(s):  
R. J. Trof ◽  
A. Beishuizen ◽  
Y. J. Debets-Ossenkopp ◽  
A. R. J. Girbes ◽  
A. B. J. Groeneveld
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Combination Therapy in Treatment of Experimental Pulmonary Aspergillosis: In Vitro and In Vivo Correlations of the Concentration- and Dose- Dependent Interactions between Anidulafungin and Voriconazole by Bliss Independence Drug Interaction Analysis

2009 ◽  
Vol 53 (6) ◽  
pp. 2382-2391 ◽  
Author(s):  
Vidmantas Petraitis ◽  
Ruta Petraitiene ◽  
William W. Hope ◽  
Joseph Meletiadis ◽  
Diana Mickiene ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Interaction Analysis ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Treatment Groups ◽  
Synergistic Interactions ◽  
Significant Difference ◽  
Bliss Independence

ABSTRACT We studied the antifungal activity of anidulafungin (AFG) in combination with voriconazole (VRC) against experimental invasive pulmonary aspergillosis (IPA) in persistently neutropenic rabbits and further explored the in vitro and in vivo correlations by using Bliss independence drug interaction analysis. Treatment groups consisted of those receiving AFG at 5 (AFG5 group) and 10 (AFG10 group) mg/kg of body weight/day, VRC at 10 mg/kg every 8 h (VRC group), AFG5 plus VRC (AFG5+VRC group), and AFG10 plus VRC (AFG10+VRC group) and untreated controls. Survival throughout the study was 60% for the AFG5+VRC group, 50% for the VRC group, 27% for the AFG10+VRC group, 22% for the AFG5 group, 18% for the AFG10 group, and 0% for control rabbits (P < 0.001). There was a significant reduction of organism-mediated pulmonary injury, measured by infarct scores, lung weights, residual fungal burdens, and galactomannan indexes, in AFG5+VRC-treated rabbits versus those treated with AFG5 and VRC alone (P < 0.05). In comparison, AFG10+VRC significantly lowered only infarct scores and lung weights in comparison to those of AFG10-treated animals (P < 0.05). AFG10+VRC showed no significant difference in other outcome variables. Significant Bliss synergy was found in vivo between AFG5 and VRC, with observed effects being 24 to 30% higher than expected levels if the drugs were acting independently. These synergistic interactions were also found between AFG and VRC in vitro. However, for AFG10+VRC, only independence and antagonism were observed among the outcome variables. We concluded that the combination of AFG with VRC in treatment of experimental IPA in persistently neutropenic rabbits was independent to synergistic at a dosage of 5 mg/kg/day but independent to antagonistic at 10 mg/kg/day, as assessed by Bliss independence analysis, suggesting that higher dosages of an echinocandin may be deleterious to the combination.

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