OBJECTIVES: The incidence of invasive pulmonary aspergillosis (IPA) among patients without immunocompromised host factors (ICHF) has been described extensively. However, its diagnosis remains challenging. To date, no study has statistically confirmed the efficacy of early IPA diagnosis in patients without ICHF.
METHODS: We conducted a cross-sectional study on mortality from IPA among patients without ICHF, using the Japanese Diagnosis Procedure Combination National Inpatient Database (April 2014-March 2018). The early diagnosis group was defined according to antifungal therapy initiation within 7 days of hospital admission. The delayed diagnosis group was defined according to antifungal therapy initiation between 8 and 28 days of the hospitalization. Associations were estimated using multivariate logistic regression.
RESULTS: A total of 423 patients were registered (early diagnosis group, n = 262, 62%). The early diagnosis group had a lower mortality rate (30%) than the delayed diagnosis group (42%). The early diagnosis group that was treated with voriconazole was associated with lower odds of mortality (odds ratio 0.55, 95% confidence interval 0.31-0.99, P = 0.047). An age of >/=65 years and mechanical ventilation were associated with a higher mortality rate.
CONCLUSION: Early diagnosis along with optimal antifungal treatment are crucial for achieving favorable outcomes among patients with IPA without ICHF.
|投稿者||Inoue, Katsuhiro; Muramatsu, Keiji; Nishimura, Takehiro; Fujino, Yoshihisa; Matsuda, Shinya; Fushimi, Kiyohide; Kamochi, Masayuki|
|組織名||Intensive Care Unit, Hospital of University of Occupational and Environmental;Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan. Electronic;address: email@example.com.;Department of Preventive Medicine and Community Health, School of Medicine,;University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,,;8078555, Japan.;Department of Environmental Epidemiology, Institute of industrial Ecological;Sciences, University of Occupational and Environmental Health, 11 Iseigaoka,;Yahatanishi, Kitakyushu, 8078555, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University;Graduate School, 1 5-45 Yushima, Bunkyo-ku, Tokyo, 1138510, Japan.;Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan.|