scholarly journals Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
G. Montrucchio ◽  
T. Lupia ◽  
D. Lombardo ◽  
G. Stroffolini ◽  
S. Corcione ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Diagnostic Category ◽  
Pulmonary Aspergillosis ◽  
Related Factors ◽  
Epidemiological Characteristics ◽  
The Impact

AbstractInvasive pulmonary aspergillosis (IPA) has always been a challenging diagnosis and risk factors an important guide to investigate specific population, especially in Intensive Care Unit. Traditionally recognized risk factors for IPA have been haematological diseases or condition associated with severe immunosuppression, lately completed by chronic conditions (such as obstructive pulmonary disease, liver cirrhosis, chronic kidney disease and diabetes), influenza infection and Intensive Care Unit (ICU) admission. Recently, a new association with SARS-CoV2 infection, named COVID-19-associated pulmonary aspergillosis (CAPA), has been reported worldwide, even if its basic epidemiological characteristics have not been completely established yet. In this narrative review, we aimed to explore the potential risk factors for the development of CAPA and to evaluate whether previous host factors or therapeutic approaches used in the treatment of COVID-19 critically ill patients (such as mechanical ventilation, intensive care management, corticosteroids, broad-spectrum antibiotics, immunomodulatory agents) may impact this new diagnostic category. Reviewing all English-language articles published from December 2019 to December 2020, we identified 21 papers describing risk factors, concerning host comorbidities, ICU management, and COVID-19 therapies. Although limited by the quality of the available literature, data seem to confirm the role of previous host risk factors, especially respiratory diseases. However, the attention is shifting from patients’ related risk factors to factors characterizing the hospital and intensive care course, deeply influenced by specific features of COVID treatment itself. Prolonged invasive or non-invasive respiratory support, as well as the impact of corticosteroids and/or immunobiological therapies seem to play a pivotal role. ICU setting related factors, such as environmental factors, isolation conditions, ventilation systems, building renovation works, and temporal spread with respect to pandemic waves, need to be considered. Large, prospective studies based on new risk factors specific for CAPA are warranted to guide surveillance and decision of when and how to treat this particular population.

scholarly journals Invasive pulmonary aspergillosis after heart transplantation

2021 ◽  
Vol 23 (2) ◽  
pp. 30-35
Author(s):  
M. A. Simonenko ◽  
M. Yu. Sitnikova ◽  
P. A. Fedotov ◽  
Yu. V. Sazonova ◽  
M. A. Bortsova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Ct Scan ◽  
Immunosuppressive Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Chest Ct ◽  
First Year ◽  
Pulmonary Aspergillosis ◽  
Chest Ct Scan

Objective: to assess the incidence, determine the peculiarities of the course of invasive pulmonary aspergillosis (IPA) and identify risk factors for IPA in heart transplant recipients.Materials and methods. From January 2010 to December 2019, 137 heart transplantations (HT) were performed: mean age 46 ± 14 years; male 102 (74%) and female 35 (26%). All patients received a three-component immunosuppressive therapy: calcineurin inhibitors, mycophenolate mofetil (MMF) and Glucocorticoid (GCs). Induction therapy consisted of Basiliximab (81%, n = 111) and antithymocyte immunoglobulin (15%, n = 20). A retrospective analysis of patients with identified post-HT invasive IPA was performed; risk factors for IPA were assessed. In patients with early IPA, the length of stay in the intensive care unit (ICU), the duration of mechanical ventilation, and the initial severity of the condition were studied. All patients with suspected pneumonia underwent bronchoscopy with examination of bronchoalveolar lavage (BAL) and chest computed tomography (chest CT scan).Results. During the follow-up, there were 58 episodes of pneumonia, of which 16 (28%) were IPA (age 33 to 64 years). All patients had a target level of immunosuppressive drugs concentration in blood; basiliximab was used as induction therapy in 15 of 16 patients. Half of the recipients developed IPA in the early post-HT period (less than 3 months after HT), in the rest (n = 8) – at a later date (3 months to 1 year after HT). The diagnosis was verified: 14 out of 16 patients showed an increase in the Aspergillus antigen positivity in the BAL to 7.2 (2.8 ± 1.6); chest CT scan revealed specific changes. In two patients, there were no diagnostic criteria for IPA, but the diagnosis was made based on the results of histological examination after resection of the left lower lobe of the lung. All patients received voriconazole therapy for 2 to 6 months, their immunosuppressive therapy was adjusted (tacrolimus and MMF dose adjustment) and their white blood cell count was monitored. Complete cure of the disease was achieved in 13 (81%) patients. Two patients died within 30 days after HT in the intensive care unit, one died from urogenital diseases caused by bacterial flora and leading to urosepsis, 4 months after IPA treatment was initiated. All patients had risk factors for IPA: taking immunosuppression, including GCs (n = 16), prolonged ICU stay (n = 14), inotropic support exceeding 2 days in the early post-transplant period (n = 10), cachexia during HT (n = 6), leukopenia (n = 9) and neutropenia (n = 14).Conclusion. In heart transplantat recipients, the incidence of IPA among respiratory tract infections is 28%. The risk of developing IPA was highest during the first year following HT. In the majority of recipients, the disease was detected at the early stages; diagnosis required surgical intervention in 12% of cases. A decrease in the risk of developing IPA was associated with correction of the following risk factors for this disease in all patients: volume of immunosuppressive therapy during the first year after transplantation and prevention of the development of neutropenia as a marker of infectious complications or immunosuppression overdose. Early diagnosis of IPA allowed for initiation of timely specific therapy in most recipients and achievement of a positive effect in 80% of them.

scholarly journals Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Piotr F. Czempik ◽  
Agnieszka Jarosińska ◽  
Krystyna Machlowska ◽  
Michał P. Pluta
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Smartphone Application ◽  
Sound Level ◽  
Related Factors ◽  
Cross Sectional ◽  
Sound Levels ◽  
The Impact

Abstract Sleep disruption is common in patients in the intensive care unit (ICU). The aim of the study was to measure sound levels during sleep-protected time in the ICU, determine sources of sound, assess the impact of sound levels and patient-related factors on duration and quality of patients' sleep. The study was performed between 2018 and 2019. A commercially available smartphone application was used to measure ambient sound levels. Sleep duration was measured using the Patient's Sleep Behaviour Observational Tool. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The study population comprised 18 (58%) men and 13 (42%) women. There were numerous sources of sound. The median duration of sleep was 5 (IQR 3.5–5.7) hours. The median score on the RCSQ was 49 (IQR 28–71) out of 100 points. Sound levels were negatively correlated with sleep duration. The cut-off peak sound level, above which sleep duration was shorter than mean sleep duration in the cohort, was 57.9 dB. Simple smartphone applications can be useful to estimate sound levels in the ICU. There are numerous sources of sound in the ICU. Individual units should identify and eliminate their own sources of sound. Sources of sound producing peak sound levels above 57.9 dB may lead to shorter sleep and should be eliminated from the ICU environment. The sound levels had no effect on sleep quality.

scholarly journals A novel diagnosis scoring model to predict invasive pulmonary aspergillosis in the intensive care unit

2019 ◽  
Vol 40 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Anna Rozaliyani ◽  
Rudyanto Sedono ◽  
Anwar Jusuf ◽  
Cleopas Rumende ◽  
Wahju Aniwidyaningsih ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Scoring Model

scholarly journals Invasive pulmonary aspergillosis in a COVID-19 recovered patient: unravelling an infective sequalae of the SARS-CoV-2 virus

2021 ◽  
Vol 91 (2) ◽  
Author(s):  
Benhur Joel Shadrach ◽  
Rishabh Goel ◽  
Kunal Deokar ◽  
Anukool Jain
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Room ◽  
Lung Disease ◽  
Invasive Pulmonary Aspergillosis ◽  
Morbidly Obese ◽  
Pulmonary Aspergillosis ◽  
The Past

Dear Editor, A 55-year-female, house wife, non-smoker, morbidly obese (BMI>35) with no other co-morbidities or pre-existing lung disease presented to the emergency room with complaints of highgrade fever, cough with minimal sputum, progressive breathlessness, streaky haemoptysis, and anorexia for the past 5 days. She was admitted in intensive care unit (ICU) for severe COVID-19 pneumonia three months back and had successfully recovered after 24 days of hospitalization....

scholarly journals Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China

2019 ◽  
Author(s):  
Yingchao Cui ◽  
Danfeng Dong ◽  
Lihua Zhang ◽  
Daosheng Wang ◽  
Cen Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Large Scale ◽  
Protective Factor ◽  
Epidemic Clone ◽  
Clostridioides Difficile ◽  
And Control ◽  
Epidemiological Characteristics

Abstract Background: Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. Methods: Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR=13.993), metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or combined antibiotics (OR=2.856). CDC patients were characterized by prolonged hospital stay (OR=1.137), increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043), and treatment with vancomycin (OR=18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR=0.042; CDC: OR=0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A+B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A+B+ and the epidemic clone was ST81. Conclusions: The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile . Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.

Invasive Pulmonary Aspergillosis in Patients With Severe Fever With Thrombocytopenia Syndrome

2019 ◽  
Author(s):  
Seongman Bae ◽  
Hye Jeon Hwang ◽  
Mi Young Kim ◽  
Min Jae Kim ◽  
Yong Pil Chong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antifungal Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Severe Fever

Abstract Sixteen of 45 patients with severe fever with thrombocytopenia (36%) were admitted to an intensive care unit; 9 (56%) developed invasive pulmonary aspergillosis (IPA) within a median of 8 days (range, 2–11). Mortality was higher in the IPA vs non-IPA patients and in those without vs with antifungal therapy.

scholarly journals Risk factors for Clostridioides difficile infection and colonization among patients admitted to an intensive care unit in Shanghai, China

2019 ◽  
Author(s):  
Yingchao Cui ◽  
Danfeng Dong ◽  
Lihua Zhang ◽  
Daosheng Wang ◽  
Cen Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Stay ◽  
Large Scale ◽  
Protective Factor ◽  
Epidemic Clone ◽  
Clostridioides Difficile ◽  
And Control ◽  
Epidemiological Characteristics

Abstract Background: Clostridioides difficile is considered the main pathogen responsible for hospital-acquired infections. This prospective study determined the prevalence, molecular epidemiological characteristics, and risk factors for C. difficile infection (CDI) and C. difficile colonization (CDC) among patients in the intensive care unit (ICU) of a large-scale tertiary hospital in China, with the aim of providing strategies for efficient CDI and CDC prevention and control. Methods: Stool samples were collected and anaerobically cultured for C. difficile detection. The identified isolates were examined for toxin genes and subjected to multilocus sequence typing. Patients were classified into CDI, CDC, and control groups, and their medical records were analyzed to determine the risk factors for CDI and CDC. Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) were identified to have CDI and CDC, respectively. Associations with CDI were found for fever (OR=13.993), metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or combined antibiotics (OR=2.856). CDC patients were characterized by prolonged hospital stay (OR=1.137), increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043), and treatment with vancomycin (OR=18.168). Notably, treatment with metronidazole was found to be a protective factor in both groups (CDI: OR=0.042; CDC: OR=0.013). Eighteen sequence types (STs) were identified. In the CDI group, the isolated strains were predominantly toxin A and toxin B positive (A+B+) and the epidemic clone was genotype ST2. In the CDC group, the dominant strains were A+B+ and the epidemic clone was ST81. Conclusions: The prevalences of CDC and CDI in our ICU were relatively high, suggesting the importance of routine screening for acquisition of C. difficile . Future prevention and treatment strategies for CDC and CDI should consider hospital stay, enteral nutrition, underlying comorbidities, and use of combined antibiotics. Moreover, metronidazole may be a protective factor for both CDI and CDC, and could be used empirically.

Sign in / Sign up

Export Citation Format

Share Document