Abstract
BACKGROUND: Liver cirrhosis causes immune dysregulation and increased susceptibility to fungal infections. We studiede risk factors, molecular epidemiology and compared the rapid diagnostic methods and biomarkers for fungal pneumonia in critically ill cirrhotics METHODS: Single-center, prospective cohort study of 50 critically ill cirrhotics with fungal pneumonia between January and September 2017. Comparative analysis of culture, real-time PCR and biomarkers; Bronchoalveolar lavage and serum galactomannan, serum procalcitonin were measured by ELISA and chemiluminescence assay on Days 1, 3, 7. Final outcome were mortality within 1 month after diagnosis or discharge. Genotyping of clinical and air sampling Aspergillus isolates was done RESULTS: Aspergillus flavus was most common species (34/50, 68%). Risk factors were, neutropenia (P 0.03), steroids prior to ICU admission (P 0.02), prolonged hospitalizations >21 days (P 0.05). Culture positivity was 80%. Culture was not inferior to real-time PCR for diagnosis of fungal pneumonia. BAL Galactomannan was early prognostic marker with median rise above >1 index value on Day 1. Median PCT level was higher from Day 1 in the fungal pneumonia nonsurvivor group (3.29 vs. 0.8 ng/mL) with higher 30-day mortality (72%). Higher PCT was associated with bacterial co-infection (48%), antibiotic(74%) and antifungal therapy and renal failure and mortality. Cinical isolates from patients matched those recovered from air in two clusters. CONCLUSION: Fungal pneumonia complicates cirrhotics with neutropenia, prolonged hospitalization and steroids as risk factors. Aspergillus species predominate as in Asian epidemiology. Culture methods are reliable and combination of molecular test with BAL galactomannan is useful for rapid diagnosis. SerumPCT is raised in patients with fungal pneumonia and associated with higher mortality. In our study the baseline PCT at admission to ICU was higher in nonsurvivor group, levels on D3 and D7 were persistantly higher. High serum procalcitonin level is an independent prognostic biomarker of mortality risk in fungal pneumonia. Genetic relatedness of clinical and environmental sample necessitates infection control measures to prevent invasive aspergillosis in high-risk patients. DISCLOSURES: All authors: No reported disclosures.