AP-HP, Hôpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Médecine, 1 avenue Claude Vellefaux, 75010 Paris, France.
Intensive Care Med. 2011 Oct;37(10):1605-12. doi: 10.1007/s00134-011-2344-8. Epub 2011 Aug 25.
Invasive pulmonary aspergillosis (IPA) is a life-threatening infection documented in up to 15% of hematology patients who require intensive care for acute respiratory failure. We report outcomes in hematology patients given mechanical ventilation (MV) with IPA.
Retrospective study of all hematology patients given MV with IPA between January 1998 and March 2011 at a single center. Predictors of 6-month survival or mortality were identified using multivariable analysis.
We studied 67 patients including 49 (73%) with neutropenia, 23 (34%) with long-term steroid therapy, and 14 (21%) with allogeneic bone marrow transplantation. Incidence of IPA in the ICU decreased between 1998 and 2011, and mortality in patients receiving mechanical ventilation did not change. IPA was confirmed in 6 patients by autopsy and was probable in 61 patients based on host factors, clinical and radiographic features, and either Aspergillus isolation (50 patients) or Aspergillus antigen detection alone (11 patients). Concomitant bacterial infections were documented in 24 (36%) patients. ICU and 6-month mortality rates were 67 and 82%, respectively. Mortality was stable throughout the study period. Concomitant bacterial infection was independently associated with higher mortality [HR, 2.1 (1.2-3.8)]. Mortality was lower in patients given voriconazole [OR, 0.5 (0.3-0.9)].
Hospital mortality remains high in hematology patients requiring MV with IPA, particularly when concommittant infection occurred. The use of voriconazole improved survival.
侵袭性肺曲霉病（IPA）是一种危及生命的感染，在因急性呼吸衰竭需要重症监护的血液病患者中发生率高达 15%。我们报告了在接受机械通气（MV）治疗的血液病患者中 IPA 的结果。
对 1998 年 1 月至 2011 年 3 月期间在一家中心接受 MV 治疗的 IPA 血液病患者进行回顾性研究。使用多变量分析确定 6 个月生存率或死亡率的预测因素。
我们研究了 67 例患者，其中 49 例（73%）中性粒细胞减少，23 例（34%）长期接受类固醇治疗，14 例（21%）接受异基因骨髓移植。1998 年至 2011 年 ICU 中 IPA 的发生率有所下降，而接受机械通气的患者的死亡率没有变化。6 例患者通过尸检证实为 IPA，61 例患者根据宿主因素、临床和影像学特征以及曲霉菌分离（50 例）或曲霉菌抗原检测（11 例）确定为 IPA。24 例（36%）患者并发细菌感染。ICU 和 6 个月的死亡率分别为 67%和 82%。死亡率在整个研究期间保持稳定。并发细菌感染与更高的死亡率独立相关[HR，2.1（1.2-3.8）]。接受伏立康唑治疗的患者死亡率较低[OR，0.5（0.3-0.9）]。
血液病患者需要 MV 治疗 IPA 时，医院死亡率仍然很高，特别是并发感染时。伏立康唑的使用提高了生存率。
