Cohort study of IPA among influenza patients in ICU reports an overall incidence of 19% and overall mortality of 51%

Submitted by BethBradshaw on 1 October 2018

Invasive pulmonary aspergillosis (IPA) is a serious infection with a high mortality rate, typically occurring in immunocompromised patients. Influenza has long been recognised as a risk factor for bacterial superinfections, but the link between IPA and severe influenza has only recently begun to be explored. A new paper by Alexander Schauwvlieghe et al., published in the Lancet, assesses the incidence of IPA in patients with severe influenza, and determines that influenza is an independent risk factor (aOR 5.19, 95% CI 2.63–10.26) for invasive pulmonary aspergillosis.

Schauwvlieghe et al. collected data from 7 different intensive care units (ICUs) over 7 influenza seasons, in the largest retrospective multicentre cohort study to date on the incidence of IPA in influenza patients. They found that the presence of influenza in non-immunocompromised pneumonia patients, admitted to the ICU, increased the risk of IPA infection from 5% to 14%. In a group of patients who were also immunocompromised, the incidence of IPA rose to 32%, with 71% of those dying within 90 days of ICU admission. 

The authors advise that the association of influenza with IPA, and the high mortality rates, justify an aggressive approach to diagnosis and further studies into the value of antifungal prophylaxis.