An Official American Thoracic Society Statement: Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients

Limper, Andrew H.; Knox, Kenneth S.; Sarosi, George A.; Ampel, Neil M.; Bennett, John E.; Catanzaro, Antonino; Davies, Scott F.; Dismukes, William E.; Hage, Chadi A.; Marr, Kieren A.; Mody, Christopher H.; Perfect, John R.; Stevens, David A.

doi:10.1164/rccm.2008-740st

Cited by 517 publications

(417 citation statements)

References 285 publications

Supporting

Mentioning

372

Contrasting

Unclassified

Order By: Relevance

“…20 Although the duration of antifungal therapy for IPA is controversial, some patients may require therapy for a long duration to prevent recurrent IPA infection. 7,20 The development of IPA should be suspected in heart transplant recipients who present with fever and respiratory symptoms during the first 3 months after transplant, have a positive culture result for Aspergillus species, and have abnormal radiographic findings, especially nodules, even in the absence of neutropenia.…”

Section: Discussionmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Küpeli̇

Ulubay²,

S³

et al. 2015

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. Materials and Methods: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. Results: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. Conclusions: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis in Heart Transplant Recipients

Küpeli̇

Ulubay²,

S³

et al. 2015

Exp Clin Transplant

View full text Add to dashboard Cite

show abstract

“…In particular, Candida pneumonia is rare, and the recovery of Candida species from respiratory-tract secretions is usually not clinically important 23 but warrants further investigation. 3 In other studies, S. epidermidis was isolated from 1.4 -7.0% of cultures 3,4,17,24 and considered either nonpathogenic 24 or pathogenic.…”

Section: Discussionmentioning

confidence: 99%

Non-Ventilator ICU-Acquired Pneumonia After Cardiothoracic Surgery: Accuracy of Diagnostic Tools and Outcomes

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Non-ventilator ICU-acquired pneumonia after cardiothoracic surgery is challenging to diagnose, and little is known about its impact on patient outcomes. Here, our primary objective was to compare the sensitivity and specificity of cultures of 2 types of fiberoptic bronchoscopy (FOB) specimens: endotracheal aspirates (FOB-EA) and bronchoalveolar lavage fluid (FOB-BAL). The secondary objectives were to evaluate the sensitivity and specificity of spontaneous sputum cultures and of the modified Clinical Pulmonary Infection Score (CPIS) and to describe patient outcomes. METHODS: We conducted a prospective observational study of consecutive cardiothoracic surgery subjects with suspected non-ventilator ICU-acquired pneumonia. Using FOB-BAL cultures >10 4 cfu/mL as the reference standard, we evaluated the accuracy of FOB-EA >10 5 cfu/mL and spontaneous sputum >10 7 cfu/mL. On the day of FOB, we determined the modified CPIS. Mortality and antibiotic treatments were recorded. RESULTS: Of 105 subjects, 57 (54.3%) received a diagnosis of non-ventilator ICU-acquired pneumonia. FOB-EA cultures had 82% (95% CI 69 -91%) sensitivity and 100% (95% CI 89 -100%) specificity and were significantly less sensitive than FOB-BAL cultures (P < .004). Spontaneous sputum was obtained from one-third of subjects. Spontaneous sputum cultures had 82% (95% CI 56 -95%) sensitivity and 94% (95% CI 68 -100%) specificity and were non-significantly less sensitive than FOB-BAL (P ‫؍‬ .061). A modified CPIS >6 had 42% (95% CI 29 -56%) sensitivity and 87% (95% CI 74 -95%) specificity for non-ventilator ICU-acquired pneumonia. Antibiotic therapy was stopped in all subjects without non-ventilator ICU-acquired pneumonia, after 1.6 ؎ 1.2 d, without deleterious effects. CONCLUSIONS: The modified CPIS has low diagnostic accuracy for non-ventilator ICU-acquired pneumonia. FOB-EA cultures perform less well than do FOB-BAL cultures for diagnosing nonventilator ICU-acquired pneumonia. Spontaneous sputum is valuable when FOB cannot be performed but could be obtained in only a minority of subjects. When cultures are negative, antibiotic discontinuation is safe.

show abstract

“…8 Our patient underwent treatment with itraconazole 200 mg twice daily, with plans to continue this for the duration of his immunosuppression. His symptoms resolved within 1 month of therapy and radiographic infiltrates were seen to be resolving at 6 weeks; he continued to do well at 12-week follow-up.…”

Section: Managementmentioning

confidence: 99%