Aspergillosis: emerging risk groups in critically ill patients
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Aspergillosis: emerging risk groups in critically ill patients. / Kluge, Stefan; Strauß, Richard; Kochanek, Matthias; Weigand, Markus A; Rohde, Holger; Lahmer, Tobias.
in: MED MYCOL, Jahrgang 60, Nr. 1, myab064, 08.12.2021.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Review › Forschung
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TY - JOUR
T1 - Aspergillosis: emerging risk groups in critically ill patients
AU - Kluge, Stefan
AU - Strauß, Richard
AU - Kochanek, Matthias
AU - Weigand, Markus A
AU - Rohde, Holger
AU - Lahmer, Tobias
PY - 2021/12/8
Y1 - 2021/12/8
N2 - UNLABELLED: Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favoring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mold-active primary prophylaxis is used in some centers according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment.LAY SUMMARY: The use of corticosteroids and the presence of co-morbidities such as chronic obstructive pulmonary disease, acute or chronic advanced liver disease, or severe viral pneumonia caused by influenza or Covid-19, may increase the risk of invasive aspergillosis in intensive care unit patients.
AB - UNLABELLED: Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favoring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mold-active primary prophylaxis is used in some centers according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment.LAY SUMMARY: The use of corticosteroids and the presence of co-morbidities such as chronic obstructive pulmonary disease, acute or chronic advanced liver disease, or severe viral pneumonia caused by influenza or Covid-19, may increase the risk of invasive aspergillosis in intensive care unit patients.
KW - Adrenal Cortex Hormones/adverse effects
KW - Aspergillosis/complications
KW - COVID-19
KW - Comorbidity
KW - Critical Illness
KW - Humans
KW - Influenza, Human
KW - Intensive Care Units
KW - Liver Diseases
KW - Pulmonary Disease, Chronic Obstructive
KW - Risk Factors
KW - Sepsis
U2 - 10.1093/mmy/myab064
DO - 10.1093/mmy/myab064
M3 - SCORING: Review article
C2 - 34677613
VL - 60
JO - MED MYCOL
JF - MED MYCOL
SN - 1369-3786
IS - 1
M1 - myab064
ER -