Cargando…
Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation
To identify the incidence, risk factors and impact on long-term survival of invasive pulmonary aspergillosis (IPA) and Aspergillus colonisation in patients receiving vv-extracorporeal membrane oxygenation (ECMO). A retrospective evaluation was performed of patients receiving vv-ECMO at a tertiary ho...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015116/ https://www.ncbi.nlm.nih.gov/pubmed/29623451 http://dx.doi.org/10.1007/s10096-018-3241-7 |
_version_ | 1783334331296514048 |
---|---|
author | Rodriguez-Goncer, I. Thomas, S. Foden, P. Richardson, M. D. Ashworth, A. Barker, J. Geraghty, C. G. Muldoon, E. G. Felton, T. W. |
author_facet | Rodriguez-Goncer, I. Thomas, S. Foden, P. Richardson, M. D. Ashworth, A. Barker, J. Geraghty, C. G. Muldoon, E. G. Felton, T. W. |
author_sort | Rodriguez-Goncer, I. |
collection | PubMed |
description | To identify the incidence, risk factors and impact on long-term survival of invasive pulmonary aspergillosis (IPA) and Aspergillus colonisation in patients receiving vv-extracorporeal membrane oxygenation (ECMO). A retrospective evaluation was performed of patients receiving vv-ECMO at a tertiary hospital in Manchester (UK) between January 2012 and December 2016. Data collected included epidemiological data, microbiological cultures, radiographic findings and outcomes. Cases were classified as proven IPA, putative IPA or Aspergillus colonisation according to a validated clinical algorithm. One hundred thirty-four patients were supported with vv-ECMO, median age of 45.5 years (range 16.4–73.4). Ten (7%) patients had putative IPA and nine (7%) had Aspergillus colonisation. Half of the patients with putative IPA lacked classical host risk factors for IPA. The median number of days on ECMO prior to Aspergillus isolation was 5 days. Immunosuppression and influenza A infection were significantly associated with developing IPA in a logistic regression model. Cox regression model demonstrates a three times greater hazard of death associated with IPA. Overall 6-month mortality rate was 38%. Patients with putative IPA and colonised patients had a 6-month mortality rate of 80 and 11%, respectively. Immunosuppression and influenza A infection are independent risk factors for IPA. IPA, but not Aspergillus colonisation, is associated with high long-term mortality in patients supported with vv-ECMO. |
format | Online Article Text |
id | pubmed-6015116 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-60151162018-07-04 Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation Rodriguez-Goncer, I. Thomas, S. Foden, P. Richardson, M. D. Ashworth, A. Barker, J. Geraghty, C. G. Muldoon, E. G. Felton, T. W. Eur J Clin Microbiol Infect Dis Original Article To identify the incidence, risk factors and impact on long-term survival of invasive pulmonary aspergillosis (IPA) and Aspergillus colonisation in patients receiving vv-extracorporeal membrane oxygenation (ECMO). A retrospective evaluation was performed of patients receiving vv-ECMO at a tertiary hospital in Manchester (UK) between January 2012 and December 2016. Data collected included epidemiological data, microbiological cultures, radiographic findings and outcomes. Cases were classified as proven IPA, putative IPA or Aspergillus colonisation according to a validated clinical algorithm. One hundred thirty-four patients were supported with vv-ECMO, median age of 45.5 years (range 16.4–73.4). Ten (7%) patients had putative IPA and nine (7%) had Aspergillus colonisation. Half of the patients with putative IPA lacked classical host risk factors for IPA. The median number of days on ECMO prior to Aspergillus isolation was 5 days. Immunosuppression and influenza A infection were significantly associated with developing IPA in a logistic regression model. Cox regression model demonstrates a three times greater hazard of death associated with IPA. Overall 6-month mortality rate was 38%. Patients with putative IPA and colonised patients had a 6-month mortality rate of 80 and 11%, respectively. Immunosuppression and influenza A infection are independent risk factors for IPA. IPA, but not Aspergillus colonisation, is associated with high long-term mortality in patients supported with vv-ECMO. Springer Berlin Heidelberg 2018-04-06 2018 /pmc/articles/PMC6015116/ /pubmed/29623451 http://dx.doi.org/10.1007/s10096-018-3241-7 Text en © The Author(s) 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Rodriguez-Goncer, I. Thomas, S. Foden, P. Richardson, M. D. Ashworth, A. Barker, J. Geraghty, C. G. Muldoon, E. G. Felton, T. W. Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
title | Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
title_full | Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
title_fullStr | Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
title_full_unstemmed | Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
title_short | Invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
title_sort | invasive pulmonary aspergillosis is associated with adverse clinical outcomes in critically ill patients receiving veno-venous extracorporeal membrane oxygenation |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6015116/ https://www.ncbi.nlm.nih.gov/pubmed/29623451 http://dx.doi.org/10.1007/s10096-018-3241-7 |
work_keys_str_mv | AT rodriguezgonceri invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT thomass invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT fodenp invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT richardsonmd invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT ashwortha invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT barkerj invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT geraghtycg invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT muldooneg invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation AT feltontw invasivepulmonaryaspergillosisisassociatedwithadverseclinicaloutcomesincriticallyillpatientsreceivingvenovenousextracorporealmembraneoxygenation |