Factors associated with coinfections in invasive aspergillosis: a retrospective cohort study

Clin Microbiol Infect. 2021 Mar 1:S1198-743X(21)00103-8. doi: 10.1016/j.cmi.2021.02.021. Online ahead of print.


OBJECTIVES: To describe the coinfections in invasive aspergillosis, to identify factors associated with coinfections and to evaluate the impact of coinfection on mortality.

PATIENTS AND METHODS: We conducted a monocentric retrospective study of consecutive putative, probable, or proven invasive aspergillosis that occurred from 1997 to 2017. All coinfections, with an onset within 7 days before or after the first sign of aspergillosis, were identified. Factors associated with coinfections and mortality were analysed by multivariable analysis.

RESULTS: Among the 690 patients with IA included in the study, median age was 57 years (range: 7 days-90 years). A coinfection was diagnosed in 272/690 (39.4%, 95%CI [35.8-43.2]) patients. The location of this coinfection was pulmonary only in 131/272 patients (48%), bloodstream only in 66/272 patients (24%) and other/multiple sites in 75/272 patients (28%). Coinfection were bacterial (n=110/272 patients, 40%), viral (n=58/272, 21%), fungal (n=57/272, 21%), parasitic (n=5/272, 2%) or due to multiple types of pathogens (n=42/272, 15%). Factors associated with a coinfection in adjusted analysis were: allogeneic haematopoietic stem cell transplantation (OR=2.3 [1.2-4.4]), other haematological malignancies (OR=2.1 [1.2-3.8]), other underlying diseases (OR=4.3 [1.4-13.6); lymphopenia (OR=1.7 [1.1-2.5]); C-reactive protein >180 mg/l (OR=1.9 [1.2-3.0]); fever (OR=2.4 [1.5-4.1]); tracheal intubation (OR=2.6 [1.5-4.7]); isolation of ≥2 different Aspergillus species (OR=2.7 [1.1-6.3]); and presence of non-nodular lesions on chest computed tomography (OR=2.2 [1.3-3.7] and OR=2.2 [1.2-4.0]). Coinfections were independently associated with a higher mortality at week 12 (adjusted HR 1.5 [1.1-1.9], p<0.01).

CONCLUSIONS: Coinfections were frequent in IA patients and were associated with higher mortality.

PMID:33662543 | DOI:10.1016/j.cmi.2021.02.021

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