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

François Danion (1) , Céline Duval (2) , François Séverac (3) , Philippe Bachellier (1) , Ermanno Candolfi (4) , Vincent Castelain (1) , Raphael Clere-Jehl (5, 1) , Julie Denis (4) , Laurence Dillenseger (1) , Eric Epailly (1) , Justine Gantzer (2) , Blandine Guffroy (2) , Yves Hansmann (1) , Jean-Etienne Herbrecht (1) , Valerie Letscher-Bru (1, 4) , Pierre Leyendecker (1) , Pauline Le van Quyen (1) , Pierre-Olivier Ludes (1) , Guillaume Morel (1) , Bruno Moulin (5, 1) , Catherine Paillard (1) , Benjamin Renaud-Picard (1, 6) , Anne-Claude Roche (1) , Alina Marcela Sabou (1, 4) , Francis Schneider (7, 1) , Morgane Solis (5, 1) , Émilie Talagrand-Reboul (8, 1) , Francis Veillon (1) , Marie-Pierre Ledoux (2) , Célestine Simand (2) , Raoul Herbrecht (2, 9)

1 HUS - Les Hôpitaux Universitaires de Strasbourg
2 ICANS - Institut de Cancérologie de Strasbourg Europe
3 ICube - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie
4 Dynamique des interactions Hôte pathogène
5 IRM - Immuno-Rhumatologie Moléculaire
6 NanoRegMed - Nanomédecine Régénérative
7 BB - Biomatériaux et Bioingénierie
8 Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë
9 IRFAC - Inserm U1113 - Interface de Recherche Fondamentale et Appliquée en Cancérologie

Objectives: To describe the coinfections in invasive aspergillosis (IA), to identify factors associated with coinfections, and to evaluate the impact of coinfection on mortality.Patients and methods: We conducted a monocentric retrospective study of consecutive putative, probable, or proven IA that occurred between 1997 and 2017. All coinfections, with an onset within 7 days before or after the first sign of aspergillosis, were identified. Factors associated with coinfections and mortality were analysed by multivariable analysis.Results: Among the 690 patients with IA included in the study, the median age was 57 years (range 7 days to 90 years). A coinfection was diagnosed in 272/690 patients (39.4%, 95%CI 35.8-43.2). 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%). Coinfections were bacterial (110/272 patients, 40%), viral (58/272, 21%), fungal (57/272, 21%), parasitic (5/272, 2%) or due to multiple types of pathogens (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 two or more different Aspergillus species (OR 2.7 (1.1-6.3)), and the 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).Conclusions: Coinfections are frequent in IA patients and are associated with higher mortality.

Mots clés: Coinfections; Fungal; Invasive fungal infections; Leukaemia; Mortality; Risk factors

Domaines: Microbiologie et Parasitologie

François Danion, Céline Duval, François Séverac, Philippe Bachellier, Ermanno Candolfi, et al.. Factors associated with coinfections in invasive aspergillosis: a retrospective cohort study. Clinical Microbiology and Infection, 2021, 27 (11), pp.1644-1651. ⟨10.1016/j.cmi.2021.02.021⟩. ⟨hal-03473453⟩