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Invasive pulmonary aspergillosis in solid‐organ transplant patients in the intensive care unit

Joachim Klein, Jordi Rello, George Dimopoulos, Pierre Bulpa, Koen Blot, Dirk Vogelaers (UGent) and Stijn Blot (UGent)
(2022) TRANSPLANT INFECTIOUS DISEASE. 24(1).
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Abstract
Introduction Solid-organ transplantation (SOT) is a well-known risk factor for invasive pulmonary aspergillosis (IPA). We report on the epidemiology and outcome of SOT patients with IPA in an intensive care unit (ICU) setting. Methods This is a secondary study based on a subset of SOT patients from a prospective observational multicenter cohort (the AspICU project) including ICU patients with at least one Aspergillus spp. positive culture. Cases were classified as proven, probable, or putative IPA, or as Aspergillus-colonized. Mortality was reported at 12 weeks. Results The study included 52 SOT patients (of which 18 lung, 17 liver, 12 kidney, and five heart transplants). Sixteen patients had proven IPA, 28 were categorized as putative IPA (of which only five reached a probable IPA diagnosis according to the European Organization for Research and Treatment of Cancer/Mycosis Study Group and Research Consortium criteria), and eight as Aspergillus-colonization. Among patients with IPA, 20 (45.5%) developed IPA during their ICU stay following transplantation whereas 24 patients (54.5%) had a medical ICU admission. Regarding medical imaging, nearly all IPA cases presented with non-specific findings as only nine demonstrated robust findings suggestive for invasive fungal disease. Overall, severity of the disease was reflected by a high prevalence of underlying conditions and acute organ derangements. Mortality among patients with IPA was 68%. Lung transplantation was associated with better survival (50%). Conclusion IPA in SOT patients in the ICU develops in the presence of overall high severity of the disease. It rarely presents with suggestive medical imaging thereby hampering diagnosis. IPA in ICU patients with SOT carries a grim prognosis.
Keywords
Infectious Diseases, Transplantation, aspergillosis, Aspergillus, intensive care, mortality, solid-organ recipient, transplantation, CRITICALLY-ILL PATIENTS, FUNGAL-INFECTIONS, RISK-FACTORS, RECIPIENTS, DEFINITIONS, MORTALITY, FEATURES, DISEASE, ICU

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Citation

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MLA
Klein, Joachim, et al. “Invasive Pulmonary Aspergillosis in Solid‐organ Transplant Patients in the Intensive Care Unit.” TRANSPLANT INFECTIOUS DISEASE, vol. 24, no. 1, 2022, doi:10.1111/tid.13746.
APA
Klein, J., Rello, J., Dimopoulos, G., Bulpa, P., Blot, K., Vogelaers, D., & Blot, S. (2022). Invasive pulmonary aspergillosis in solid‐organ transplant patients in the intensive care unit. TRANSPLANT INFECTIOUS DISEASE, 24(1). https://doi.org/10.1111/tid.13746
Chicago author-date
Klein, Joachim, Jordi Rello, George Dimopoulos, Pierre Bulpa, Koen Blot, Dirk Vogelaers, and Stijn Blot. 2022. “Invasive Pulmonary Aspergillosis in Solid‐organ Transplant Patients in the Intensive Care Unit.” TRANSPLANT INFECTIOUS DISEASE 24 (1). https://doi.org/10.1111/tid.13746.
Chicago author-date (all authors)
Klein, Joachim, Jordi Rello, George Dimopoulos, Pierre Bulpa, Koen Blot, Dirk Vogelaers, and Stijn Blot. 2022. “Invasive Pulmonary Aspergillosis in Solid‐organ Transplant Patients in the Intensive Care Unit.” TRANSPLANT INFECTIOUS DISEASE 24 (1). doi:10.1111/tid.13746.
Vancouver
1.
Klein J, Rello J, Dimopoulos G, Bulpa P, Blot K, Vogelaers D, et al. Invasive pulmonary aspergillosis in solid‐organ transplant patients in the intensive care unit. TRANSPLANT INFECTIOUS DISEASE. 2022;24(1).
IEEE
[1]
J. Klein et al., “Invasive pulmonary aspergillosis in solid‐organ transplant patients in the intensive care unit,” TRANSPLANT INFECTIOUS DISEASE, vol. 24, no. 1, 2022.
@article{8735974,
  abstract     = {{Introduction Solid-organ transplantation (SOT) is a well-known risk factor for invasive pulmonary aspergillosis (IPA). We report on the epidemiology and outcome of SOT patients with IPA in an intensive care unit (ICU) setting. Methods This is a secondary study based on a subset of SOT patients from a prospective observational multicenter cohort (the AspICU project) including ICU patients with at least one Aspergillus spp. positive culture. Cases were classified as proven, probable, or putative IPA, or as Aspergillus-colonized. Mortality was reported at 12 weeks. Results The study included 52 SOT patients (of which 18 lung, 17 liver, 12 kidney, and five heart transplants). Sixteen patients had proven IPA, 28 were categorized as putative IPA (of which only five reached a probable IPA diagnosis according to the European Organization for Research and Treatment of Cancer/Mycosis Study Group and Research Consortium criteria), and eight as Aspergillus-colonization. Among patients with IPA, 20 (45.5%) developed IPA during their ICU stay following transplantation whereas 24 patients (54.5%) had a medical ICU admission. Regarding medical imaging, nearly all IPA cases presented with non-specific findings as only nine demonstrated robust findings suggestive for invasive fungal disease. Overall, severity of the disease was reflected by a high prevalence of underlying conditions and acute organ derangements. Mortality among patients with IPA was 68%. Lung transplantation was associated with better survival (50%). Conclusion IPA in SOT patients in the ICU develops in the presence of overall high severity of the disease. It rarely presents with suggestive medical imaging thereby hampering diagnosis. IPA in ICU patients with SOT carries a grim prognosis.}},
  articleno    = {{e13746}},
  author       = {{Klein, Joachim and Rello, Jordi and Dimopoulos, George and Bulpa, Pierre and Blot, Koen and Vogelaers, Dirk and Blot, Stijn}},
  issn         = {{1398-2273}},
  journal      = {{TRANSPLANT INFECTIOUS DISEASE}},
  keywords     = {{Infectious Diseases,Transplantation,aspergillosis,Aspergillus,intensive care,mortality,solid-organ recipient,transplantation,CRITICALLY-ILL PATIENTS,FUNGAL-INFECTIONS,RISK-FACTORS,RECIPIENTS,DEFINITIONS,MORTALITY,FEATURES,DISEASE,ICU}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{11}},
  title        = {{Invasive pulmonary aspergillosis in solid‐organ transplant patients in the intensive care unit}},
  url          = {{http://doi.org/10.1111/tid.13746}},
  volume       = {{24}},
  year         = {{2022}},
}
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