Universität zu Köln

Kluge, Stefan ORCID: 0000-0001-8391-3988, Strauss, Richard, Kochanek, Matthias ORCID: 0000-0002-4766-4651, Weigand, Markus A., Rohde, Holger and Lahmer, Tobias (2021). Aspergillosis: Emerging risk groups in critically ill patients. Med. Mycol., 60 (1). OXFORD: OXFORD UNIV PRESS. ISSN 1460-2709

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Abstract

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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kluge, Stefan UNSPECIFIED orcid.org/0000-0001-8391-3988 UNSPECIFIED Strauss, Richard UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, Matthias UNSPECIFIED orcid.org/0000-0002-4766-4651 UNSPECIFIED Weigand, Markus A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rohde, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED Lahmer, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-593469
DOI:	10.1093/mmy/myab064
Journal or Publication Title:	Med. Mycol.
Volume:	60
Number:	1
Date:	2021
Publisher:	OXFORD UNIV PRESS
Place of Publication:	OXFORD
ISSN:	1460-2709
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE PULMONARY ASPERGILLOSIS; POLYMERASE-CHAIN-REACTION; NON-NEUTROPENIC PATIENTS; INTENSIVE-CARE-UNIT; LATERAL-FLOW DEVICE; BETA-D-GLUCAN; FUNGAL-INFECTIONS; MOLD INFECTIONS; SEPTIC SHOCK; HEMATOLOGICAL MALIGNANCIES Multiple languages Infectious Diseases; Mycology; Veterinary Sciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/59346