Invasive Tracheobronchial Aspergillosis in Critically III Patients with Severe Influenza A Clinical Trial
Invasive Tracheobronchial Aspergillosis in Critically III Patients with Severe Influenza A Clinical Trial
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DOI：
10.1164/rccm.201910-1931oc
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发表时间：
2020-09-01
影响因子：
24.7
通讯作者：
Zogheib, Elie
中科院分区：
文献类型：
--
作者：
Nyga, Remy;Maizel, Julien;Zogheib, Elie
基本原理：侵袭性气管支气管曲霉病（Invasive tracheobronchial aspergillosis，ITBA）是侵袭性肺曲霉病的一种罕见但严重的临床形式，其中真菌感染完全或主要局限于气管支气管树。目的：分析重症流感患者中气管支气管曲霉病与无气管支气管病变的肺曲霉病之间的诊断和预后差异。方法：这项回顾性、观察性研究纳入了2010年至2019年期间来自三家医院ICU的流感相关肺曲霉病重症患者。患者的特点和临床和真菌学数据在入院和ICU住院期间收集在一个数据库中，以评估变量在两个groups. Measures和主要结果：35例重症流感和肺曲霉菌病入住ICU。10例患者被纳入ITBA组（n = 10/35; 28.6%），25例患者被纳入无ITBA组。ITBA组包括更多主动吸烟、糖尿病和更高严重程度评分（简化急性生理学评分II）的患者。有和无ITBA组的90天死亡率分别为90%和44%（P = 0.02）。此外，与未使用ITBA的组相比，使用ITBA的组中观察到血清1，3-β-D-葡聚糖和半乳甘露聚糖以及BAL液半乳甘露聚糖浓度显著更高（分别为P < 0.0001、P = 0.003和P = 0.008）。与无气管支气管病变的侵袭性肺曲霉病相比，ITBA与更高的严重程度评分、死亡率、血清和BAL液半乳甘露聚糖和1，3-β-D-葡聚糖浓度相关。对于合并肺曲霉菌病和流感的ICU患者，应通过支气管镜检查对ITBA进行系统研究。
Rationale: Invasive tracheobronchial aspergillosis (ITBA) is an uncommon but severe clinical form of invasive pulmonary aspergillosis in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree.Objectives: To analyze the diagnostic and prognostic differences between tracheobronchial aspergillosis and pulmonary aspergillosis without tracheobronchial lesions among patients admitted to the ICU with severe influenza.Methods: This retrospective, observational study included critically ill patients with influenza associated with pulmonary aspergillosis from three hospital ICUs between 2010 and 2019. Patient characteristics and clinical and mycologic data at admission and during ICU stay were collected in a database to evaluate variables in the two groups.Measurements and Main Results: Thirty-five patients admitted to the ICU with severe influenza and pulmonary aspergillosis were included. Ten patients were included in the group with ITBA (n = 10 of 35; 28.6%), and 25 patients were included in the group without ITBA. The group with ITBA comprised more patients with active smoking, diabetes mellitus, and higher severity scores (Simplified Acute Physiology Score II). Ninety-day mortality rates in the groups with and without ITBA were 90% and 44%, respectively (P = 0.02). Moreover, significantly higher serum 1,3-beta-D-glucan and galactomannan and BAL fluid galactomannan concentrations were observed in the group with ITBA compared with the group without ITBA (P < 0.0001, P = 0.003, and P = 0.008, respectively).Conclusions: ITBA was associated with higher severity scores, mortality, and serum and BAL fluid galactomannan and 1,3-beta-D-glucan concentrations than invasive pulmonary aspergillosis without tracheobronchial lesions. ITBA should be systematically researched by bronchoscopic examination in ICU patients with concomitant pulmonary aspergillosis and influenza.