Álvarez Lerma F, Olaechea Astigarraga P, Palomar Martínez M, Rodríguez Carvajal M, Machado Casas J F, Jiménez Quintana M M, Esteve Urbano F, Ballesteros Herráez J C, Zavala Zegarra E
Servicio de Medicina Intensiva, Hospital del Mar, Parc de Salut Mar, Barcelona, España.
Servicio de Medicina Intensiva, Hospital de Galdakao, Galdakao, España.
Med Intensiva. 2015 Apr;39(3):149-59. doi: 10.1016/j.medin.2014.02.004. Epub 2014 Apr 6.
The presence of respiratory fungal infection in the critically ill patient is associated with high morbidity and mortality.
To assess the incidence of respiratory infection caused by Aspergillus spp. independently of the origin of infection in patients admitted to Spanish ICUs, as well as to describe the rates, characteristics, outcomes and prognostic factors in patients with this type of infection.
An observational, retrospective, open-label and multicenter study was carried out in a cohort of patients with respiratory infection caused by Aspergillus spp. admitted to Spanish ICUs between 2006 and 2012 (months of April, May and June), and included in the ENVIN-HELICS registry (108,244 patients and 825,797 days of ICU stay). Variables independently related to in-hospital mortality were identified by multiple logistic regression analysis.
A total of 267 patients from 79 of the 198 participating ICUs were included (2.46 cases per 1000 ICU patients and 3.23 episodes per 10,000 days of ICU stay). From a clinical point of view, infections were classified as ventilator-associated pneumonia in 93 cases (34.8%), pneumonia unrelated to mechanical ventilation in 120 cases (44.9%), and tracheobronchitis in 54 cases (20.2%). The study population included older patients (mean 64.8±17.1 years), with a high severity level (APACHE II score 22.03±7.7), clinical diseases (64.8%) and prolonged hospital stay before the identification of Aspergillus spp. (median 11 days), transferred to the ICU mainly from hospital wards (58.1%) and with high ICU (57.3%) and hospital (59.6%) mortality rates, exhibiting important differences depending on the type of infection involved. Independent mortality risk factors were previous admission to a hospital ward (OR=7.08, 95%CI: 3.18-15.76), a history of immunosuppression (OR=2.52, 95%CI: 1.24-5.13) and severe sepsis or septic shock (OR=8.91, 95%CI: 4.24-18.76).
Respiratory infections caused by Aspergillus spp. in critically ill patients admitted to the ICU in Spain are infrequent, and affect a very selected group of patients, characterized by high mortality and conditioned by non-modifiable risk factors.
危重症患者发生呼吸道真菌感染与高发病率和高死亡率相关。
评估西班牙重症监护病房（ICU）收治患者中由曲霉菌属引起的呼吸道感染的发病率，而不考虑感染源，同时描述此类感染患者的发生率、特征、转归及预后因素。
对2006年至2012年（4月、5月和6月）期间入住西班牙ICU且由曲霉菌属引起呼吸道感染的患者队列进行了一项观察性、回顾性、开放标签的多中心研究，这些患者纳入了ENVIN-HELICS注册研究（共108244例患者，ICU住院天数达825797天）。通过多因素logistic回归分析确定与院内死亡率独立相关的变量。
来自198个参与研究的ICU中的79个ICU的267例患者被纳入研究（每1000例ICU患者中有2.46例，每10000个ICU住院日中有3.23次发作）。从临床角度来看，93例（34.8%）感染被分类为呼吸机相关性肺炎，120例（44.9%）为与机械通气无关的肺炎，54例（20.2%）为气管支气管炎。研究人群包括老年患者（平均64.8±17.1岁），病情严重程度高（急性生理与慢性健康状况评分系统II [APACHE II]评分为22.03±7.7），有临床疾病（64.8%），在确诊曲霉菌属之前住院时间延长（中位数为11天），主要从医院病房转入ICU（58.1%），ICU死亡率（57.3%）和医院死亡率（59.6%）高，且根据所涉及的感染类型存在重要差异。独立的死亡危险因素为既往入住医院病房（比值比[OR]=7.08，95%置信区间[CI]：3.18 - 15.76）、免疫抑制病史（OR=2.52，95%CI：1.24 - 5.13）以及严重脓毒症或脓毒性休克（OR=8.91，95%CI：4.24 - 18.76）。
在西班牙入住ICU的危重症患者中，由曲霉菌属引起的呼吸道感染并不常见，且影响的是经过高度筛选的一组患者，其特点是死亡率高且受不可改变的危险因素影响。
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