Invasive pulmonary aspergillosis (IPA) is an increasingly recognised
problem in critically ill patients. Little is known about how
intensivists react to an Aspergillus-positive respiratory sample or the
efficacy of antifungal therapy (AFT). This study aimed to identify
drivers of AFT prescription and diagnostic workup in patients with
Aspergillus isolation in respiratory specimens as well as the impact of
AFT in these patients. ICU patients with an Aspergillus-positive
respiratory sample from the database of a previous observational,
multicentre study were analysed. Cases were classified as
proven/putative IPA or Aspergillus colonisation. Demographic,
microbiological, diagnostic and therapeutic data were collected. Outcome
was recorded 12 weeks after Aspergillus isolation. Patients with
putative/proven IPA were more likely to receive AFT than colonised
patients (78.7% vs. 25.5%; P < 0.001). Patients with host factors for
invasive fungal disease were more likely to receive AFT (72.5% vs.
37.4%) as were those with multiorgan failure (SOFA score >7) (68.4%
vs. 36.9%) (both P < 0.001). Once adjusted for disease severity,
initiation of AFT did not alter the odds of survival (HR = 1.40, 95% CI
0.89-2.21). Likewise, treatment within 48 h following diagnosis did not
change the clinical outcome (75.7% vs. 61.4%; P = 0.63). Treatment
decisions appear to be based on diagnostic criteria and underlying
disease severity at the time of Aspergillus isolation. IPA in this
population has a dire prognosis and AFT is not associated with reduced
mortality. This may be explained by delayed diagnosis and an often
inevitable death due to advanced multiorgan failure. (C) 2017 Elsevier
B.V. and International Society of Chemotherapy. All rights reserved