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Abstract
Background
Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality in immunocompromised patients. However, few data on clinical characteristics and outcomes of IPA in Korea have been reported. We conducted a nationwide multicenter study in Korea for evaluation of the epidemiology and clinical outcomes of invasive pulmonary aspergillosis.
Materials and Methods
A retrospective cohort study was conducted in 10 hospitals in Korea. We reviewed all adult patients who met the revised EORTC/MSG definitions between 2008 and 2010.
Results
A total of 334 cases, which included proven (26, 8%), probable (159, 48%), or possible (149, 44%) IPA, were identified. Patients with proven or probable IPA were evaluated, and, of these 185 IPA patients, 105 (57%) had neutropenia, 30 (16%) underwent hematopoietic stem cell transplantation, 25 (14%) underwent solid organ transplantation, and 32 (17%) without neutropenia and transplantation received immunosuppressive agents or corticosteroid. Aspergillus spp. were isolated from 42 patients (23%), and positive fungal culture rates from sterile fluid, sputum, and bronchoalveolar lavage fluid (BAL) were 67% (6/9), 21% (32/150), and 20% (9/44), respectively. Results of assays for sensitivity of serum and BAL galactomannan were 84% (155/184) and 89% (25/28), respectively. Amphotericin-B deoxycholate and itraconazole were most commonly administered as a primary therapy in 107 (58%) and 34 (19%) patients, respectively. Of 133 patients (73%) who received salvage therapy after primary antifungal therapy for a median period of six days (IQR 3-12), 82 (62%) patients were treated with voriconazole. Of 185 patients, 82 (44%) died within three months after diagnosis of IPA. CT findings, including small airway lesions and micronodules, ground glass opacities, and pleural effusion and persistent positive galactomannan status showed an independent association with worse outcome, while proven diagnosis of IPA showed an independent association with better outcome.
Conclusions
Microbiologic confirmation of IPA was low in Korea; therefore, many Korean physicians were dependent on the galactomannan assay for microbiologic diagnosis. Primary therapy with Amphotericin-B deoxycholate followed by salvage therapy with voriconazole was the most common antifungal strategy for treatment of patients with IPA in Korea. Overall mortality and IPA-related mortality were comparable with data from Western clinical trials.
Figures and Tables
Table 1
Baseline Characteristics of Patients with Invasion Pulmonary Aspergillosis
Data indicate proportion (%) of patients or patients tested.
IPA, invasive pulmonary aspergillosis; BAL, bronchoalveolar lavage; GM, galactomannan; IQR, inter-quartile range; CT,computed tomography.
aOf 26 patients with confirmed IPA, five showed positive results of sterile culture and the remaining 21 showed histologic findings compatible with IPA. Of these 21 patients, 11 showed a positive result for the serum or BAL GM assay and six patients showed positive results for sterile or non-sterile culture, four showed positive results for the serum or BAL GM assay and for sterile or non-sterile culture.
bOf 159 patients with probable IPA, 126 showed a positive result for the serum or BAL GM assay, 13 showed positive results for non-sterile culture, and 20 showed positive results for both the serum or BAL GM assays and for non-sterile culture.
cP values for Confirmed IPA vs Probable IPA.
dOf 30 hematopoietic stem cell transplant recipients with confirmed and probable IPA, 17 (57%) with neutropenia were classified as the neutropenia group. Of 21 with possible IPA, 13 (62%) with neutropenia were classified as the neutropenia group.
eOf 25 solid organ transplant recipients with confirmed and probable IPA, one (4%) with neutropenia was classified as the neutropenia group.
fPatients without neutropenia and transplantation who received immunosuppressive agents or corticosteroid were classified as each respective category.
References
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