• Anne Coste, Aurélien Frérou, Anaïs Raute, Francis Couturaud, Jean Morin, Pierre-Yves Egreteau, François-Xavier Blanc, Jean Reignier, Jean-Marc Tadié, Adissa Tran, Charlotte Pronier, Marianne Coste-Burel, Gilles Nevez, Jean-Pierre Gangneux, Patrice Le Pape, Séverine Ansart, Jean-Marie Tonnelier, Cédric Bretonnière, and Cécile Aubron.
• Medical Intensive Care Unit, Centre Hospitalier et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France.
• Crit. Care Med. 2021 Jun 1; 49 (6): 934-942.

ObjectivesTo determine the frequency and prognosis of invasive pulmonary aspergillosis in critically ill patients with severe influenza pneumonia.DesignRetrospective multicenter cohort study.SettingFive French ICUs.PatientsPatients with influenza admitted to ICU between 2009 and 2018.Measurements And Main ResultsOf the 524 patients admitted for severe influenza diagnosed with a positive airway reverse-transcriptase polymerase chain reaction test, 450 (86%) required mechanical ventilation. A lower respiratory tract sample yielded with Aspergillus (Asp+) in 28 patients (5.3%). Ten patients (1.9%) were diagnosed with putative or proven invasive pulmonary aspergillosis, based on the validated AspICU algorithm. A multivariate model was built to identify independent risk factors for Aspergillus-positive pulmonary culture. Factors independently associated with Aspergillus-positive culture were liver cirrhosis (odds ratio = 6.7 [2.1-19.4]; p < 0.01), hematologic malignancy (odds ratio = 3.3 [1.2-8.5]; p = 0.02), Influenza A(H1N1)pdm09 subtype (odds ratio = 3.9 [1.6-9.1]; p < 0.01), and vasopressor requirement (odds ratio = 4.1 [1.6-12.7]; p < 0.01). In-hospital mortality of Asp+ patients was 36% versus 21% in patients without Aspergillus-positive pulmonary culture (p = 0.09).ConclusionsIn this large retrospective multicenter cohort of critically ill patients, putative invasive pulmonary aspergillosis according to AspICU algorithm was a relatively rare complication of influenza. Patients at higher risk of Aspergillus pulmonary colonization included those with liver cirrhosis, hematologic malignancy, H1N1pdm09 influenza A virus, and requiring vasopressors. Our results provide additional data on the controversial association between severe influenza and invasive pulmonary aspergillosis. Reaching a consensual definition of invasive pulmonary aspergillosis becomes mandatory and confers further prospective research.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

19 keywords...

hide…