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Abstract:

Objectives: Using criteria designed for invasive aspergillosis (IA) in neutropenic patients, the present study aimed to determine the impact of invasive aspergillosis in different groups of non-haemato-oncological ICU patients. Methods: This study is a retrospective analysis of all patients that were hospitalised in the 17-bed medical intensive care unit (MICU) between 1 January 2000 and 1 January 2003. Any admitted patient fulfilling one or more of the following criteria was included in the study: (a) histopathological evidence of Aspergillosis (including autopsy) or (b) microbiological evidence of aspergillosis during stay in the MICU (positive culture or positive circulating galactomannan). IA was classified as proven, probable or possible, according to the EORTC/MSG definitions. Aspergillus isolation from a non-sterile site in patients without appropriate clinical setting was considered as ‘colonisation’. Results: Between 2000 and 2003, 127 of 1850 patients (6.9%) fulfilled the inclusion criteria. Thirty-eight patients (29%) had haematological malignancies and were not further analysed. Eighty-nine (71%) were non-haemato-oncological patients (37 COPD, nine solid organ transplant recipients, 17 autoimmune diseases, six cirrhosis patients and 20 miscellaneous). Following the EORTC/MSG criteria, these patients were classified as proven IA (n = 30), probable IA (n = 37), possible IA (n = 2) and ‘colonisation’ (n = 20). Mean SAPS II score was 52 with a predicted mortality of 48.6%. Overall mortality was 80% (n = 71). Mortality of the proven and probable group was 96.7 and 86.5%, respectively. Among the 18 patients who survived, 10 just had ‘colonisation’ with Aspergillus. Post-mortem examination in the non-haemato-oncological group was done in 46 out of the 71 patients who died (70%) and 29/46 autopsies (63%) showed hyphael invasion with Aspergillus (mainly the lung as target organ). There were five proven cases in patients without compromising host factors according to the EORTC/MSG definitions (three liver cirrhosis, one pneumonia in a 95-year-old man, one Klebsiella sepsis with MOF). Conclusion: IA is an emerging infectious disease in non-haemato-oncological ICU patients. There seems to be a broad group of patients at risk of IA. IA was diagnosed in patients without characteristics described in the EORTC/MSG definitions. It seems worthwhile to investigate the validity of the available diagnostic tools in non-haemato-oncological patients at risk for IA in a prospective manner.