Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases: a prospective study.
Crit Care. 2011 Jan 6;15(1):R5
Authors: He H, Ding L, Li F, Zhan Q
ABSTRACT: INTRODUCTION: Critically ill patients with chronic obstructive respiratory diseases (CORD) who require intensive care unit (ICU) admission are at particular risk for invasive bronchial-pulmonary aspergillosis (IBPA). The purpose of this study is to investigate clinical features for rapid recognition of IBPA in critically ill patients with CORD. METHODS: We included 55 consecutive CORD patients in a respiratory ICU in a prospective, single-center, cohort study. In this study, IBPA combined 2 entities: ATB and IPA. RESULTS: Thirteen of 55 patients were diagnosed with IBPA. Prior to ICU admission, three variables were independent predictors of IBPA with statistical significance: more than 3 kinds of antibiotics used prior to the ICU admission, accumulated doses of corticosteroids (>350 mg) received prior to the ICU admission and APACHE II scores >18 (OR=1.208, P=0.022; OR=8.661, P=0.038; OR=19.488, P=0.008, respectively). After ICU admission, more IBPA patients had high fever (>38.5) (46.2% vs. 11.9%, P=0.021), wheeze without exertion (84.6% vs. 50.0%, P=0.027), dry rales (84.6% vs. 40.4%, P=0.005), higher white blood cell counts (21x10^9/L vs. 9.4x10^9/L, P=0.012), lower mean arterial pressures (77.9 mmHg vs. 90.5 mmHg, P=0.019) and serum creatinine clearances (36.2 ml/min vs. 68.8ml/min, P<0.001), and liver function and coagulation abnormalities. Bronchospasm, sputum ropiness and plaque formation were more common for IBPA patients during bronchoscopy (66.7% vs. 14.3%; P=0.082. 18% vs. 0%; P=0.169. and 73% vs. 13%; P=0.003, respectively). More IBPA patients had nodules and patchiness on chest X-ray on day 1 of admission, which rapidly progressed to consolidation on day 7. IBPA mortality was higher than that of non-IBPA patients (69.2% vs. 16.7%, P=0.001). CONCLUSIONS: IBPA may be suspected in critically ill CORD patients with respiratory failure and clinical and bronchoscopic manifestations of severe infection, bronchospasm and rapid progression of radiological lesions, which are irresponsive to steroids and antibiotics. To avoid misdiagnosis and establish the microbiologic etiology, early bronchoscopy and tight radiological follow-up should be performed.
PMID: 21211008 [PubMed - as supplied by publisher]