Pulmonary Aspergillosis in Patients with Suspected Ventilator-associated Pneumonia in UK Intensive Care Units

Laura Loughlin, Thomas P Hellyer, P Lewis White, Danny F McAuley, Andrew Conway Morris, Raquel B Posso, Malcolm D Richardson, David W Denning, A John Simpson, Ronan McMullan

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Abstract

RATIONALE: Aspergillus infection in patients with suspected ventilator-associated pneumonia remains uncharacterised due to absence of a disease definition and limited access to sensitive diagnostic tests.

OBJECTIVES: To estimate the prevalence and outcomes of Aspergillus infection in adults with suspected ventilator associated pneumonia.

METHODS: Two prospective UK studies recruited 360 critically ill adults with new or worsening alveolar shadowing on chest X-ray and clinical/haematological parameters supporting suspected ventilator-associated pneumonia. Stored serum and bronchoalveolar lavage fluid were available from 194 non-neutropenic patients and underwent mycological testing. Patients were categorized as having probable Aspergillus infection using a definition comprising clinical, radiological and mycological criteria. Mycological criteria included: positive histology or microscopy; positive bronchoalveolar lavage fluid culture; galactomannan optical index ≥1 in bronchoalveolar lavage fluid or ≥0·5 in serum.

MEASUREMENTS AND MAIN RESULTS: Of 194 patients evaluated, 24 met the definition of probable Aspergillus infection, giving an estimated prevalence of 12·4% (95% CI 8·1-17·8). All 24 patients had positive galactomannan in serum (n=4), bronchoalveolar lavage fluid (n=16), or both (n=4); three patients cultured Aspergillus sp. in bronchoalveolar lavage fluid. Patients with probable Aspergillus infection had significantly longer median duration of critical care stay (25·5vs15·5 days, p=0·02). ICU mortality was numerically higher in this group although was not statistically significant (33·3%vs22·8%, p=0·23).

CONCLUSIONS: The estimated prevalence for probable Aspergillus infection in this geographically dispersed multicentre UK cohort indicates that this condition should be considered when investigating patients with suspected ventilator-associated pneumonia, including patient groups not previously recognised to be at high risk of aspergillosis.

Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume202
Issue number8
Early online date01 Jul 2020
DOIs
Publication statusPublished - 15 Oct 2020

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