Schauwvlieghe AFAD, et al. - In patients with influenza pneumonia in the intensive care unit (ICU), experts measured the incidence of invasive pulmonary aspergillosis over several seasons and evaluated if influenza was an independent risk factor for invasive pulmonary aspergillosis. For invasive pulmonary aspergillosis, influenza was identified as an independent risk factor and was seen to be related to high mortality.

Methods

• Researchers conducted a retrospective multicentre cohort study.
• They collected the data from adult patients with severe influenza admitted to seven ICUs across Belgium and The Netherlands during seven influenza seasons.
• The patients included in this study were older than 18 years.
• They admitted them to the ICU for more than 24 h with acute respiratory failure, had pulmonary infiltrates on imaging, and a confirmed influenza infection based on a positive airway PCR test (influenza cohort).
• They used logistic regression analyses to ascertain whether influenza was independently related to invasive pulmonary aspergillosis in non-immunocompromised (ie, no European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [EORTC/MSG] host factor) influenza-positive patients (influenza case group) vs non-immunocompromised patients with severe community-acquired pneumonia who had a negative airway influenza PCR test (control group).

Results

• As per the findings, data were collected from patients admitted to the ICU between Jan 1, 2009, and June 30, 2016.
• In 83 (19%) of 432 patients admitted with influenza (influenza cohort) invasive pulmonary aspergillosis was diagnosed at a median of 3 days after admission to the ICU.
• They noted similar incidence for for influenza A and B.
• Incidence of invasive pulmonary aspergillosis was as high as 32% (38 of 117 patients) for patients with influenza who were immunocompromised, whereas in the non-immunocompromised influenza case group, incidence was 14% (45 of 315 patients).
• On the contrary, invasive pulmonary aspergillosis developed in only 16 (5%) of 315 patients.
• In patients in the influenza cohort with invasive pulmonary aspergillosis, the 90-day mortality was 51% and 28% in the influenza cohort without invasive pulmonary aspergillosis (p=0·0001).
• Findings suggested an independent association of influenza with invasive pulmonary aspergillosis (adjusted odds ratio 5·19; 95% CI 2·63–10·26; p < 0·0001), along with a higher APACHE II score, male sex, and use of corticosteroids.