Influenza-associated invasive aspergillosis in patients admitted to the intensive care unit in Sweden: a prospective multicentre cohort study

Anders Krifors, Ola Blennow, Lisa I Påhlman, Patrik Gille-Johnson, Helena Janols, Miklos Lipcsey, Jan Källman, Johan Tham, Anna Stjärne Aspelund, Oskar Ljungquist, Fredrik Hammarskjöld, Anita Hällgren, Lina De Geer, Marie Lemberg, Johan Petersson, Markus Castegren

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskriftPeer review

Sammanfattning

BACKGROUND: The purpose of this study was to prospectively investigate the incidence of influenza-associated pulmonary aspergillosis (IAPA) in influenza patients admitted to intensive care units in Sweden.

METHODS: The study included consecutive adult patients with PCR-verified influenza A or B in 12 Swedish intensive care units (ICUs) over four influenza seasons (2019-2023). Patients were screened using serum galactomannan and β-d-glucan tests and fungal culture of a respiratory sample at inclusion and weekly during the ICU stay. Bronchoalveolar lavage was performed if clinically feasible. IAPA was classified according to recently proposed case definitions.

RESULTS: The cohort included 55 patients; 42% were female, and the median age was 59 (IQR 48-71) years. All patients had at least one galactomannan test, β-d-glucan test and respiratory culture performed. Bronchoalveolar lavage was performed in 24 (44%) of the patients. Five (9%, 95% CI 3.8% - 20.4%) patients were classified as probable IAPA, of which four lacked classical risk factors. The overall ICU mortality was significantly higher among IAPA patients than non-IAPA patients (60% vs 8%, p  = 0.01).

CONCLUSIONS: The study represents the first prospective investigation of IAPA incidence. The 9% incidence of IAPA confirms the increased risk of invasive pulmonary aspergillosis among influenza patients admitted to the ICU. Therefore, it appears reasonable to implement a screening protocol for the early diagnosis and treatment of IAPA in influenza patients receiving intensive care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04172610, registered November 21, 2019.

Originalspråkengelska
Sidor (från-till)110-115
TidskriftInfectious Diseases
Volym56
Nummer2
Tidigt onlinedatum2023 okt. 28
DOI
StatusPublished - 2024

Ämnesklassifikation (UKÄ)

  • Infektionsmedicin

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