Prognostic Scores and Azole-Resistant Aspergillus fumigatus in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion).

Yubhisha Dabas,Anant Mohan,Immaculata Xess

doi:10.3390/jof7110991

Abstract

Objective: To assess the effectiveness of three general prognostic models (APACHE II, SAPS II, and SOFA) with serum galactomannan antigen in a clinically suspected invasive aspergillosis (IA) subpopulation admitted to a respiratory medicine ICU and to identify azole-resistant Aspergillus fumigatus (ARAF) cases. Methodology and Results: A total of 235 clinically suspected IA patients were prospectively enrolled and observed 30-day mortality was 29.7%. The three general models showed poor discrimination assessed by area under receiver operating characteristic (ROC) curves (AUCs, <0.7) and good calibration (p = 0.92, 0.14, and 0.13 for APACHE II, SAPS II, and SOFA, respectively), evaluated using Hosmer–Lemeshow goodness-of-fit tests. However, discrimination was significantly better with galactomannan values (AUC, 0.924). In-vitro antifungal testing revealed higher minimum inhibitory concentration (MIC) for 12/34 isolates (35.3%) whereas azole resistance was noted in 40% of Aspergillus fumigatus isolates (6/15) with two hotspot cyp51A mutations, G54R and P216L. Conclusions: Patients diagnosed with putative and probable IA (71.4% and 34.6%, respectively), had high mortality. The general prognostic model APACHE II seemed fairly accurate for this subpopulation. However, the use of local GM cut-offs calculated for mortality, may help the intensivists in prompt initiation or change of therapy for better outcome of patients. In addition, the high MICs highlight the need of antifungal surveillance to know the local resistance rate which might aid in patient treatment.

Highlights

IntroductionPublisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations
We identified the different factors associated with mortality and evaluated and compared the effectiveness of established general scoring systems (APACHE II, Simplified Acute Physiology Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA)) and the galactomannan antigen (GM) test in the prediction of intensive care units (ICUs) mortality of invasive aspergillosis (IA)-suspected patients
We evaluated two standard microbroth dilution methods of antifungal susceptibility testing including the Clinical Laboratory Standards Institute (CLSI)-approved CLSI M38-A2 and the European Committee on Antimicrobial Susceptibility Testing (EUCAST)-approved EUCAST Edef 9.3 for the antifungal susceptibility patterns from IA cases in our respiratory medicine ICU

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Invasive aspergillosis (IA), a known condition of immunocompromised patients has long been accepted as an emerging opportunistic infection in critically ill patients [1,2,3]. The advent of fungal infections in intensive care units (ICUs) has been attributed to the advances in life-support systems, extensive use of broad-spectrum antibiotics and invasive devices, and an increase in the susceptible patient population [4]. The delay in IA recognition in these patients can be due to the diagnostic limitations in ICU settings [1,2,3]

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