Intensive Care Medicine

, 37:1605 | Cite as

Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis

  • Gaston Burghi
  • Virginie Lemiale
  • Amélie Seguin
  • Jérôme Lambert
  • Claire Lacroix
  • Emmanuel Canet
  • Anne-Sophie Moreau
  • Patricia Ribaud
  • David Schnell
  • Eric Mariotte
  • Benoît Schlemmer
  • Elie Azoulay
Original

Abstract

Background

Invasive pulmonary aspergillosis (IPA) is a life-threatening infection documented in up to 15% of hematology patients who require intensive care for acute respiratory failure. We report outcomes in hematology patients given mechanical ventilation (MV) with IPA.

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.

Results

We 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)].

Conclusion

Hospital mortality remains high in hematology patients requiring MV with IPA, particularly when concommittant infection occurred. The use of voriconazole improved survival.

Keywords

Aspergillosis ICU Mechanical ventilation Outcome 

Supplementary material

134_2011_2344_MOESM1_ESM.doc (39 kb)
Supplementary material 1 (DOC 39 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Gaston Burghi
    • 1
  • Virginie Lemiale
    • 1
  • Amélie Seguin
    • 1
  • Jérôme Lambert
    • 2
  • Claire Lacroix
    • 3
  • Emmanuel Canet
    • 1
  • Anne-Sophie Moreau
    • 1
  • Patricia Ribaud
    • 4
  • David Schnell
    • 1
  • Eric Mariotte
    • 1
  • Benoît Schlemmer
    • 1
  • Elie Azoulay
    • 1
  1. 1.AP-HP, Hôpital Saint-Louis, Medical ICUUniversity Paris-7 Paris-Diderot, UFR de MédecineParisFrance
  2. 2.AP-HP, Hôpital Saint-Louis, DBIMUniversity Paris-7 Paris-Diderot, UFR de MédecineParisFrance
  3. 3.Mycology Department, AP-HP, Hôpital Saint-LouisUniversity Paris-7 Paris-Diderot, UFR de MédecineParisFrance
  4. 4.Haematology Department, AP-HP, Hôpital Saint-LouisUniversity Paris-7 Paris-Diderot, UFR de MédecineParisFrance

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