Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)

<b>Objective:</b> To assess the effectiveness of three general prognostic models (APACHE II, SAPS II, and SOFA) with serum galactomannan antigen in a clinically suspected invasive aspergillosis (IA) subpopulation admitted to a respiratory medicine ICU and to identify azole-resistant <...

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Autores principales:	Yubhisha Dabas, Anant Mohan, Immaculata Xess
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	invasive aspergillosis respiratory medicine ICU severity scores galactomannan antigen mortality azole-resistant <i>Aspergillus fumigatus</i> Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/6f3a53d51bc845eab303341c07d49260
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spelling	oai:doaj.org-article:6f3a53d51bc845eab303341c07d492602021-11-25T18:06:37ZPrognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)10.3390/jof71109912309-608Xhttps://doaj.org/article/6f3a53d51bc845eab303341c07d492602021-11-01T00:00:00Zhttps://www.mdpi.com/2309-608X/7/11/991https://doaj.org/toc/2309-608X<b>Objective:</b> To assess the effectiveness of three general prognostic models (APACHE II, SAPS II, and SOFA) with serum galactomannan antigen in a clinically suspected invasive aspergillosis (IA) subpopulation admitted to a respiratory medicine ICU and to identify azole-resistant <i>Aspergillus fumigatus</i> (ARAF) cases. <b>Methodology and Results:</b> A total of 235 clinically suspected IA patients were prospectively enrolled and observed 30-day mortality was 29.7%. The three general models showed poor discrimination assessed by area under receiver operating characteristic (ROC) curves (AUCs, <0.7) and good calibration (<i>p</i> = 0.92, 0.14, and 0.13 for APACHE II, SAPS II, and SOFA, respectively), evaluated using Hosmer–Lemeshow goodness-of-fit tests. However, discrimination was significantly better with galactomannan values (AUC, 0.924). In-vitro antifungal testing revealed higher minimum inhibitory concentration (MIC) for 12/34 isolates (35.3%) whereas azole resistance was noted in 40% of <i>Aspergillus fumigatus</i> isolates (6/15) with two hotspot cyp51A mutations, G54R and P216L. <b>Conclusions:</b> Patients diagnosed with putative and probable IA (71.4% and 34.6%, respectively), had high mortality. The general prognostic model APACHE II seemed fairly accurate for this subpopulation. However, the use of local GM cut-offs calculated for mortality, may help the intensivists in prompt initiation or change of therapy for better outcome of patients. In addition, the high MICs highlight the need of antifungal surveillance to know the local resistance rate which might aid in patient treatment.Yubhisha DabasAnant MohanImmaculata XessMDPI AGarticleinvasive aspergillosisrespiratory medicine ICUseverity scoresgalactomannan antigenmortalityazole-resistant <i>Aspergillus fumigatus</i>Biology (General)QH301-705.5ENJournal of Fungi, Vol 7, Iss 991, p 991 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	invasive aspergillosis respiratory medicine ICU severity scores galactomannan antigen mortality azole-resistant <i>Aspergillus fumigatus</i> Biology (General) QH301-705.5
spellingShingle	invasive aspergillosis respiratory medicine ICU severity scores galactomannan antigen mortality azole-resistant <i>Aspergillus fumigatus</i> Biology (General) QH301-705.5 Yubhisha Dabas Anant Mohan Immaculata Xess Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
description	<b>Objective:</b> To assess the effectiveness of three general prognostic models (APACHE II, SAPS II, and SOFA) with serum galactomannan antigen in a clinically suspected invasive aspergillosis (IA) subpopulation admitted to a respiratory medicine ICU and to identify azole-resistant <i>Aspergillus fumigatus</i> (ARAF) cases. <b>Methodology and Results:</b> A total of 235 clinically suspected IA patients were prospectively enrolled and observed 30-day mortality was 29.7%. The three general models showed poor discrimination assessed by area under receiver operating characteristic (ROC) curves (AUCs, <0.7) and good calibration (<i>p</i> = 0.92, 0.14, and 0.13 for APACHE II, SAPS II, and SOFA, respectively), evaluated using Hosmer–Lemeshow goodness-of-fit tests. However, discrimination was significantly better with galactomannan values (AUC, 0.924). In-vitro antifungal testing revealed higher minimum inhibitory concentration (MIC) for 12/34 isolates (35.3%) whereas azole resistance was noted in 40% of <i>Aspergillus fumigatus</i> isolates (6/15) with two hotspot cyp51A mutations, G54R and P216L. <b>Conclusions:</b> Patients diagnosed with putative and probable IA (71.4% and 34.6%, respectively), had high mortality. The general prognostic model APACHE II seemed fairly accurate for this subpopulation. However, the use of local GM cut-offs calculated for mortality, may help the intensivists in prompt initiation or change of therapy for better outcome of patients. In addition, the high MICs highlight the need of antifungal surveillance to know the local resistance rate which might aid in patient treatment.
format	article
author	Yubhisha Dabas Anant Mohan Immaculata Xess
author_facet	Yubhisha Dabas Anant Mohan Immaculata Xess
author_sort	Yubhisha Dabas
title	Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
title_short	Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
title_full	Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
title_fullStr	Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
title_full_unstemmed	Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)
title_sort	prognostic scores and azole-resistant <i>aspergillus fumigatus</i> in invasive aspergillosis from an indian respiratory medicine icu (icu patients with ia suspicion)
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6f3a53d51bc845eab303341c07d49260
work_keys_str_mv	AT yubhishadabas prognosticscoresandazoleresistantiaspergillusfumigatusiininvasiveaspergillosisfromanindianrespiratorymedicineicuicupatientswithiasuspicion AT anantmohan prognosticscoresandazoleresistantiaspergillusfumigatusiininvasiveaspergillosisfromanindianrespiratorymedicineicuicupatientswithiasuspicion AT immaculataxess prognosticscoresandazoleresistantiaspergillusfumigatusiininvasiveaspergillosisfromanindianrespiratorymedicineicuicupatientswithiasuspicion
_version_	1718411620784275456

Prognostic Scores and Azole-Resistant <i>Aspergillus fumigatus</i> in Invasive Aspergillosis from an Indian Respiratory Medicine ICU (ICU Patients with IA Suspicion)

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