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

Abstract

OBJECTIVES\nTo describe the coinfections in invasive aspergillosis, to identify factors associated with coinfections and to evaluate the impact of coinfection on mortality.\n\n\nPATIENTS AND METHODS\nWe conducted a monocentric retrospective study of consecutive putative, probable, or proven invasive aspergillosis that occurred from 1997 to 2017. All coinfections, with an onset within 7\xa0days before or after the first sign of aspergillosis, were identified. Factors associated with coinfections and mortality were analysed by multivariable analysis.\n\n\nRESULTS\nAmong the 690 patients with IA included in the study, median age was 57\xa0years (range: 7 days-90 years). A coinfection was diagnosed in 272/690 (39.4%, 95%CI [35.8-43.2]) patients. 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%). Coinfection were bacterial (n=110/272 patients, 40%), viral (n=58/272, 21%), fungal (n=57/272, 21%), parasitic (n=5/272, 2%) or due to multiple types of pathogens (n=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 ≥2 different Aspergillus species (OR=2.7 [1.1-6.3]); and 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).\n\n\nCONCLUSIONS\nCoinfections were frequent in IA patients and were associated with higher mortality.