Gaston Burghi Virginie Lemiale Ame ´lie Seguin Je ´ro ˆme Lambert Claire Lacroix Emmanuel Canet Anne-Sophie Moreau Patricia Ribaud David Schnell Eric Mariotte Benoı ˆt Schlemmer Elie Azoulay Outcomes of mechanically ventilated hematology patients with invasive pulmonary aspergillosis Received: 18 February 2011 Accepted: 22 June 2011 Published online: 25 August 2011 Ó Copyright jointly held by Springer and ESICM 2011 Electronic supplementary material The online version of this article (doi:10.1007/s00134-011-2344-8) contains supplementary material, which is available to authorized users. G. Burghi Á V. Lemiale Á A. Seguin Á E. Canet Á A.-S. Moreau Á D. Schnell Á E. Mariotte Á B. Schlemmer Á E. Azoulay ( ) ) AP-HP, Ho ˆpital Saint-Louis, Medical ICU, University Paris-7 Paris-Diderot, UFR de Me ´decine, 1 avenue Claude Vellefaux, 75010 Paris, France e-mail: elie.azoulay@sls.aphp.fr Tel.: ?330-142-499-421 Fax: ?33-142-499-426 J. Lambert AP-HP, Ho ˆpital Saint-Louis, DBIM, University Paris-7 Paris-Diderot, UFR de Me ´decine, Paris, France C. Lacroix Mycology Department, AP-HP, Ho ˆpital Saint-Louis, University Paris-7 Paris-Diderot, UFR de Me ´decine, Paris, France P. Ribaud Haematology Department, AP-HP, Ho ˆpital Saint-Louis, University Paris-7 Paris-Diderot, UFR de Me ´decine, Paris, France Abstract Background: Invasive pulmonary aspergillosis (IPA) is a life-threatening infection documented in up to 15% of hematology patients who require intensive care for acute respiratory failure. We report out- comes in hematology patients given mechanical ventilation (MV) with IPA. Methods: Retrospective study of all hematology patients given MV with IPA between January 1998 and March 2011 at a single center. Pre- dictors of 6-month survival or mortality were identified using mul- tivariable analysis. Results: We studied 67 patients including 49 (73%) with neutropenia, 23 (34%) with long-term steroid therapy, and 14 (21%) with allogeneic bone mar- row transplantation. Incidence of IPA in the ICU decreased between 1998 and 2011, and mortality in patients receiving mechanical ventilation did not change. IPA was confirmed in 6 patients by autopsy and was probable in 61 patients based on host factors, clinical and radiographic features, and either Aspergillus isolation (50 patients) or Aspergillus antigen detection alone (11 patients). Con- comitant bacterial infections were documented in 24 (36%) patients. ICU and 6-month mortality rates were 67 and 82%, respectively. Mortality was stable throughout the study per- iod. Concomitant bacterial infection was independently associated with higher mortality [HR, 2.1 (1.2–3.8)]. Mortality was lower in patients given voriconazole [OR, 0.5 (0.3–0.9)]. Conclusion: Hospital mortality remains high in hematology patients requiring MV with IPA, particularly when concommittant infection occurred. The use of voriconazole improved survival. Keywords Aspergillosis Á ICU Á Mechanical ventilation Á Outcome Introduction Invasive pulmonary aspergillosis (IPA) is a life-threat- ening complication of hematological malignancies [1–3]. In recent studies, 1-year mortality in patients with IPA was about 60% [4]. Risk factors for IPA among patients with hematological malignancies include prolonged neu- tropenia and bone marrow transplantation (BMT) [3, 5]. Another risk factor is long-term steroid therapy, which is associated with quantitative and qualitative functional impairments of macrophages, monocytes, neutrophils, and lymphocytes [5]. Intensive Care Med (2011) 37:1605–1612 DOI 10.1007/s00134-011-2344-8 ORIGINAL