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

Clin Microbiol Infect. 2021 Nov;27(11):1644-1651. doi: 10.1016/j.cmi.2021.02.021. Epub 2021 Mar 2.

Abstract

Objectives: To describe the coinfections in invasive aspergillosis (IA), 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 IA that occurred between 1997 and 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, the median age was 57 years (range 7 days to 90 years). A coinfection was diagnosed in 272/690 patients (39.4%, 95%CI 35.8-43.2). 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%). Coinfections were bacterial (110/272 patients, 40%), viral (58/272, 21%), fungal (57/272, 21%), parasitic (5/272, 2%) or due to multiple types of pathogens (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 two or more different Aspergillus species (OR 2.7 (1.1-6.3)), and the 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 are frequent in IA patients and are associated with higher mortality.

Keywords: Coinfections; Fungal; Invasive fungal infections; Leukaemia; Mortality; Risk factors.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Aspergillosis* / epidemiology
  • Aspergillosis* / mortality
  • Child
  • Child, Preschool
  • Coinfection* / epidemiology
  • Hematologic Neoplasms
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Infant
  • Infant, Newborn
  • Invasive Fungal Infections* / epidemiology
  • Invasive Fungal Infections* / mortality
  • Middle Aged
  • Retrospective Studies
  • Young Adult