Approach to invasive pulmonary aspergillosis in critically ill patients

Koulenti, Despoina, Garnacho-Montero, Jose and Blot, Stijn (2014) Approach to invasive pulmonary aspergillosis in critically ill patients. Current Opinion in Infectious Diseases, 27 2: 174-183. doi:10.1097/QCO.0000000000000043


Author Koulenti, Despoina
Garnacho-Montero, Jose
Blot, Stijn
Title Approach to invasive pulmonary aspergillosis in critically ill patients
Journal name Current Opinion in Infectious Diseases   Check publisher's open access policy
ISSN 0951-7375
1473-6527
1080-7861
Publication date 2014-04
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1097/QCO.0000000000000043
Open Access Status
Volume 27
Issue 2
Start page 174
End page 183
Total pages 10
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Collection year 2015
Language eng
Formatted abstract
Purpose of review: Apparently immunocompetent critically ill patients represent an increasing population at risk for invasive pulmonary aspergillosis (IPA). The current review gives an update on the epidemiology, diagnosis, and management of IPA in the ICU.

Recent findings: Patients without apparent severe immunosuppression (e.g. chronic obstructive pulmonary disease, decompensated liver disease, etc.) represent the majority of ICU IPA cases. IPA diagnosis is problematic and the true incidence of IPA is difficult to be estimated because of the nonspecific clinical presentation. A user-friendly clinical diagnostic algorithm for IPA is valuable, particularly through a high negative predictive value. IPA carries a poor prognosis and has an important impact on hospital costs. Timely diagnosis and prompt administration of appropriate treatment may improve the outcomes. Intravenous voriconazole is the recommended primary IPA treatment, but liposomal amphotericin B also has clinical utility. Voriconazole presents bioavailability and toxicity issues, and drug level monitoring is advocated. Caspofungin or antifungal combinations are recommended as salvage therapy.

Summary: A high level of suspicion in critically ill patients presenting with Aspergillus-positive respiratory tract cultures or nonresolving pulmonary infection may lead to earlier IPA diagnosis. Dosage individualization may decrease treatment discontinuation and improve clinical efficacy.
Keyword Critical care
Diagnosis
Invasive pulmonary aspergillosis
Outcomes
Risk factors
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
School of Medicine Publications
 
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