Infect Chemother.  2012 Aug;44(4):282-288. 10.3947/ic.2012.44.4.282.

Epidemiology and Clinical outcomes of Invasive Pulmonary Aspergillosis: A Nationwide Multicenter Study in Korea

• Kim SH
• Moon SM
• Han SH
• Chung JW
• Moon SY
• Lee MS
• Choo EJ
• Choi YH
• Kim SW
• Bae IG
• Kwon HH
• Peck KR
• Kim YS

• KMID: 2045548
• DOI: http://doi.org/10.3947/ic.2012.44.4.282

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.

Keyword

Invasive pulmonary aspergillosis; Epidemiology; Outcome

MeSH Terms

Adult
Aspergillus
Bronchoalveolar Lavage Fluid
Cohort Studies
Deoxycholic Acid
Glass
Hematopoietic Stem Cell Transplantation
Humans
Immunocompromised Host
Immunosuppressive Agents
Invasive Pulmonary Aspergillosis
Itraconazole
Korea
Mannans
Neutropenia
Organ Transplantation
Pleural Effusion
Pyrimidines
Retrospective Studies
Salvage Therapy
Sputum
Transplants
Triazoles
Deoxycholic Acid
Immunosuppressive Agents
Itraconazole
Mannans
Pyrimidines
Triazoles

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