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Elderly versus nonelderly patients with invasive aspergillosis in the ICU : a comparison and risk factor analysis for mortality from the AspICU cohort

(2018) MEDICAL MYCOLOGY. 56(6). p.668-678
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Organization
Abstract
Data regarding the epidemiology and diagnosis of invasive aspergillosis in the critically ill population are limited, with data regarding elderly patients (>= 75 years old) even scarcer. We aimed to further compare the epidemiology, characteristics and outcome of elderly versus nonelderly critically ill patients with invasive aspergillosis (IA) Prospective, international, multicenter observational study (AspICU) including adult intensive care unit (ICU) patients, with a culture and/or direct examination and/or histopathological sample positive for Aspergillusspp. at any site. We compared clinical characteristics and outcome of IA in ICU patients using two different diagnostic algorithms. Elderly and nonelderly ICU patients with IA differed in a number of characteristics, including comorbidities, clinical features of the disease, mycology testing, and radiological findings. No difference regarding mortality was found. According to the clinical algorithm, elderly patients were more likely to be diagnosed with putative IA. Elderly patients had less diagnostic radiological findings and when these findings were present they were detected late in the disease course. The comparison between elderly survivors and nonsurvivors demonstrated differences in clinical characteristics of the disease, affected sites and supportive therapy needed. All patients who were diagnosed with proven IA died. Increased vigilance combined with active search for mycological laboratory evidence and radiological confirmation are necessary for the timely diagnosis of IA in the elderly patient subset. Although elderly state per se is not a particular risk factor for mortality, a high SOFA score and the decision not to administer antifungal therapy may have an impact on survival of elderly patients.
Keywords
galactomannan, aspergillosis, elderly, mortality, aspergillus, octogenarian, CRITICALLY-ILL PATIENTS, INTENSIVE-CARE-UNIT, PULMONARY ASPERGILLOSIS, IMMUNOCOMPROMISED PATIENTS, FUNGAL-INFECTIONS, EARLY-DIAGNOSIS, DISEASE, GALACTOMANNAN, CONSENSUS, CT

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Citation

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Chicago
Matthaiou, Dimitrios K, George Dimopoulos, Fabio Taccone, Anne-Marie Van Den Abeele, Benoit Misset, Wouter Meersseman, Herbert Spapen, et al. 2018. “Elderly Versus Nonelderly Patients with Invasive Aspergillosis in the ICU : a Comparison and Risk Factor Analysis for Mortality from the AspICU Cohort.” Medical Mycology 56 (6): 668–678.
APA
Matthaiou, D. K., Dimopoulos, G., Taccone, F., Van Den Abeele, A.-M., Misset, B., Meersseman, W., Spapen, H., et al. (2018). Elderly versus nonelderly patients with invasive aspergillosis in the ICU : a comparison and risk factor analysis for mortality from the AspICU cohort. MEDICAL MYCOLOGY, 56(6), 668–678.
Vancouver
1.
Matthaiou DK, Dimopoulos G, Taccone F, Van Den Abeele A-M, Misset B, Meersseman W, et al. Elderly versus nonelderly patients with invasive aspergillosis in the ICU : a comparison and risk factor analysis for mortality from the AspICU cohort. MEDICAL MYCOLOGY. 2018;56(6):668–78.
MLA
Matthaiou, Dimitrios K, George Dimopoulos, Fabio Taccone, et al. “Elderly Versus Nonelderly Patients with Invasive Aspergillosis in the ICU : a Comparison and Risk Factor Analysis for Mortality from the AspICU Cohort.” MEDICAL MYCOLOGY 56.6 (2018): 668–678. Print.
@article{8542598,
  abstract     = {Data regarding the epidemiology and diagnosis of invasive aspergillosis in the critically ill population are limited, with data regarding elderly patients ({\textrangle}= 75 years old) even scarcer. We aimed to further compare the epidemiology, characteristics and outcome of elderly versus nonelderly critically ill patients with invasive aspergillosis (IA) Prospective, international, multicenter observational study (AspICU) including adult intensive care unit (ICU) patients, with a culture and/or direct examination and/or histopathological sample positive for Aspergillusspp. at any site. We compared clinical characteristics and outcome of IA in ICU patients using two different diagnostic algorithms. Elderly and nonelderly ICU patients with IA differed in a number of characteristics, including comorbidities, clinical features of the disease, mycology testing, and radiological findings. No difference regarding mortality was found. According to the clinical algorithm, elderly patients were more likely to be diagnosed with putative IA. Elderly patients had less diagnostic radiological findings and when these findings were present they were detected late in the disease course. The comparison between elderly survivors and nonsurvivors demonstrated differences in clinical characteristics of the disease, affected sites and supportive therapy needed. All patients who were diagnosed with proven IA died. Increased vigilance combined with active search for mycological laboratory evidence and radiological confirmation are necessary for the timely diagnosis of IA in the elderly patient subset. Although elderly state per se is not a particular risk factor for mortality, a high SOFA score and the decision not to administer antifungal therapy may have an impact on survival of elderly patients.},
  author       = {Matthaiou, Dimitrios K and Dimopoulos, George and Taccone, Fabio and Van Den Abeele, Anne-Marie and Misset, Benoit and Meersseman, Wouter and Spapen, Herbert and Cardoso, Teresa and Charles, Pierre-Emmanuel and Vogelaers, Dirk and Blot, Stijn},
  issn         = {1369-3786},
  journal      = {MEDICAL MYCOLOGY},
  keyword      = {galactomannan,aspergillosis,elderly,mortality,aspergillus,octogenarian,CRITICALLY-ILL PATIENTS,INTENSIVE-CARE-UNIT,PULMONARY ASPERGILLOSIS,IMMUNOCOMPROMISED PATIENTS,FUNGAL-INFECTIONS,EARLY-DIAGNOSIS,DISEASE,GALACTOMANNAN,CONSENSUS,CT},
  language     = {eng},
  number       = {6},
  pages        = {668--678},
  title        = {Elderly versus nonelderly patients with invasive aspergillosis in the ICU : a comparison and risk factor analysis for mortality from the AspICU cohort},
  url          = {http://dx.doi.org/10.1093/mmy/myx117},
  volume       = {56},
  year         = {2018},
}

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