Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients: A Swiss multicenter cohort study on IAPA in critically ill influenza patients.

Waldeck, Frederike; Boroli, Filippo; Zingg, Sandra; Walti, Laura N; Wendel-Garcia, Pedro David; Conen, Anna; Pagani, Jean-Luc; Boggian, Katia; Schnorf, Madeleine; Siegemund, Martin; Abed-Maillard, Samia; Michot, Marc; Que, Yok-Ai; Bättig, Veronika; Suh, Noémie; Kleger, Gian-Reto; Albrich, Werner C (2023). Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients: A Swiss multicenter cohort study on IAPA in critically ill influenza patients. Influenza and other respiratory viruses, 17(1), e13059. Wiley 10.1111/irv.13059

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BACKGROUND

Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality.

METHODS

We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/2018 and 2019/2020 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24 h were included. IAPA was diagnosed according to previously published clinical, radiological, and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome, which was a composite of in-hospital mortality, ICU length of stay ≥7 days, mechanical ventilation ≥7 days, or extracorporeal membrane oxygenation.

RESULTS

One hundred fifty-eight patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, P = 0.05). Asthma (OR 12.0 [95% CI 2.1-67.2]) and days of mechanical ventilation (OR 1.1 [1.1-1.2]) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, P = 0.001) and vasoactive support (75% vs. 45%, P = 0.03) and had more complications including ARDS (53% vs. 26%, P = 0.04), respiratory bacterial infections (65% vs. 37%, P = 0.04), and higher ICU-mortality (35% vs. 16.4%, P = 0.05). IAPA (OR 28.8 [3.3-253.4]), influenza A (OR 3.3 [1.4-7.8]), and higher SAPS II score (OR 1.07 [1.05-1.10]) were independent predictors of poor outcome.

INTERPRETATION

High clinical suspicion, early diagnostics, and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Walti, Laura Naëmi, Que, Yok-Ai

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1750-2659

Publisher:

Wiley

Language:

English

Submitter:

Pubmed Import

Date Deposited:

23 Nov 2022 10:57

Last Modified:

28 Jan 2023 00:14

Publisher DOI:

10.1111/irv.13059

PubMed ID:

36394086

Uncontrolled Keywords:

asthma influenza influenza-associated aspergillosis intensive care medicine invasive aspergillosis

BORIS DOI:

10.48350/174872

URI:

https://boris.unibe.ch/id/eprint/174872

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