Aspergillus infections in transplant and non-transplant surgical patients

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Abstract

Background: Aspergillus infections are associated with immunocompromised states, such as transplantation, and hematological malignancy. Although Aspergillus infections occur primarily in transplant recipients among surgical patients, they are occasionally found in non-transplant recipients and may be associated with mortality. Hypothesis: We hypothesized that Aspergillus infections in non-transplant patients are not uncommon, are associated with critical illness, and mortality is similar to that within transplant patients. Methods: Retrospective analysis of a prospective database from 1996-2010 was performed. Institutional review board approval was obtained. Patients with cultures positive for Aspergillus were identified. Demographics, co-morbidities, and outcomes (death, total days of antibiotics, and hospital length of stay) were compared between nontransplant and transplant recipients (with approximately 150 transplants/year in our center). Continuous data were evaluated using the Student t-test. Categorical data were evaluated using chi-square analysis. Results: Twenty-three patients were identified as having Aspergillus infections (11 transplant patients and 12 non-transplant patients). The transplant patients included: 1 kidney, 2 kidney/pancreas, and 8 liver recipients. The two groups were similar regarding patient demographics and co-morbidities, with the exception of APACHE II score (transplant 23.6 (plus or minus) 8.1 vs. non-transplant 16.8 (plus or minus) 6.1, p = 0.03), Acute Physiology Score (16.6 (plus or minus) 8.3 vs. 9.2 (plus or minus) 4.1, p = 0.02), steroid use (91.0% vs. 25.0%, p = 0.003), and percentage of infections acquired in the ICU (27.3% vs. 83.3%, p = 0.01). The most common site of infection in both groups was the lung. There was no significant difference in the number of days from admission to treatment (16.7 (plus or minus) 19.8 vs. 19.0 (plus or minus) 14.6, p = 0.76) or hospital length of stay following treatment (33.3 (plus or minus) 39.5 vs. 38.8 (plus or minus) 49.0, p = 0.77). There was no significant difference in mortality between the groups (54.5% vs. 33.3%, p = 0.41). Conclusions: Although Aspergillus infections among surgical patients have been historically associatedwith solid organ transplantation, our data suggest that others may also be significantly susceptible, especially those that are ventilated, within the ICU, or hospitalized for prolonged duration. Surgical intensivists should be familiar with the diagnosis and treatment of Aspergillus infections even in the absence of an active transplant program.

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