Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study
Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study
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DOI：
10.1016/s2213-2600(18)30274-1
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发表时间：
2018-10-01
影响因子：
76.2
通讯作者：
wauters, Joost
中科院分区：
文献类型：
--
作者：
Schauwvlieghe, Alexander F. A. D.;Rijnders, Bart J. A.;wauters, Joost
背景侵袭性肺曲霉菌病通常发生在免疫功能低下的宿主。近一个世纪以来，人们一直知道流感会导致细菌重叠感染，但最近有报道称，严重流感的患者也会患上侵袭性肺曲霉菌病。我们的目的是测量重症监护病房(ICU)流感肺炎患者不同季节侵袭性肺曲霉菌病的发病率，并评估流感是否是侵袭性肺曲霉菌病的独立危险因素。数据是从比利时和荷兰的七个流感季节住进七个ICU的严重流感成年患者收集的。患者年龄超过18岁，因急性呼吸衰竭在ICU住院超过24小时，在影像上有肺浸润物，根据阳性呼吸道聚合酶链式反应试验(流感队列)确诊为流感感染。我们使用Logistic回归分析来确定在非免疫受损(即，没有欧洲癌症/侵袭性真菌感染研究和治疗合作小组和国家过敏和传染病真菌病研究小组[EORTC/MSG]宿主因素)流感阳性患者(流感病例组)与呼吸道流感PCR检测阴性的非免疫受损社区获得性肺炎患者(对照组)中，流感是否与侵袭性肺曲霉菌病独立相关。调查数据来自2009年1月1日至2016年6月30日期间入住ICU的患者。在432名流行性感冒(流感队列)患者中，83人(19%)被诊断为侵袭性肺曲霉菌病，中位数为入院后3天。甲型流感和乙型流感的发病率相似。在免疫功能低下的流感患者中，侵袭性肺曲霉菌病的发病率高达32%(117例患者中有38例)，而在非免疫功能低下病例组中，发病率为14%(315例患者中有45例)。相反，在对照组的315名患者中，只有16名(5%)发展为侵袭性肺曲霉菌病。在有侵袭性肺曲霉菌病的流感队列患者中，90天的死亡率为51%，在没有侵袭性肺曲霉菌病的流感队列患者中，90天死亡率为28%(p=0.0001)。在这项研究中，发现流感与侵袭性肺曲霉菌病独立相关(调整后的优势比为5.19；95%可信区间为2.63-10.26；p
Background Invasive pulmonary aspergillosis typically occurs in an immunocompromised host. For almost a century, influenza has been known to set up for bacterial superinfections, but recently patients with severe influenza were also reported to develop invasive pulmonary aspergillosis. We aimed to measure the incidence of invasive pulmonary aspergillosis over several seasons in patients with influenza pneumonia in the intensive care unit (ICU) and to assess whether influenza was an independent risk factor for invasive pulmonary aspergillosis.Methods We did a retrospective multicentre cohort study. Data were collected from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons. Patients were older than 18 years, were admitted to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort). We used logistic regression analyses to determine if influenza was independently associated with invasive pulmonary aspergillosis in non-immunocompromised (ie, no European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [EORTC/MSG] host factor) influenza-positive patients (influenza case group) compared with nonimmunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).Findings Data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016. Invasive pulmonary aspergillosis was diagnosed in 83 (19%) of 432 patients admitted with influenza (influenza cohort), a median of 3 days after admission to the ICU. The incidence was similar for influenza A and B. For patients with influenza who were immunocompromised, incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients), whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients). Conversely, only 16 (5%) of 315 patients in the control group developed invasive pulmonary aspergillosis. The 90-day mortality was 51% in patients in the influenza cohort with invasive pulmonary aspergillosis and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0.0001). In this study, influenza was found to be independently associated with invasive pulmonary aspergillosis (adjusted odds ratio 5.19; 95% CI 2.63-10.26; p