학술논문
High Burden of COVID-19-Associated Pulmonary Aspergillosis in Severely Immunocompromised Patients Requiring Mechanical Ventilation.
Document Type
Article
Author
Feys, Simon; Lagrou, Katrien; Lauwers, Hanne Moon; Haenen, Koen; Jacobs, Cato; Brusselmans, Marius; Debaveye, Yves; Hermans, Greet; Hoenigl, Martin; Maertens, Johan; Meersseman, Philippe; Peetermans, Marijke; Spriet, Isabel; Vandenbriele, Christophe; Vanderbeke, Lore; Vos, Robin; Wijngaerden, Eric Van; Wilmer, Alexander; Wauters, Joost
Source
Subject
*INTENSIVE care units
*ANTIFUNGAL agents
*COVID-19
*SCIENTIFIC observation
*ACADEMIC medical centers
*BRONCHOALVEOLAR lavage
*IMMUNOCOMPROMISED patients
*COVID-19 vaccines
*CRITICALLY ill
*SUPERINFECTION
*PATIENTS
*RETROSPECTIVE studies
*PULMONARY aspergillosis
*ARTIFICIAL respiration
*COMPARATIVE studies
*RISK assessment
*PREVENTIVE health services
*DESCRIPTIVE statistics
*RESEARCH funding
*DISEASE risk factors
MORTALITY risk factors
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Language
ISSN
1058-4838
Abstract
Background Coronavirus disease 2019 (COVID-19)–associated pulmonary aspergillosis (CAPA) is a frequent superinfection in critically ill patients with COVID-19 and is associated with increased mortality rates. The increasing proportion of severely immunocompromised patients with COVID-19 who require mechanical ventilation warrants research into the incidence and impact of CAPA during the vaccination era. Methods We performed a retrospective, monocentric, observational study. We collected data from adult patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit (ICU) of University Hospitals Leuven, a tertiary referral center, between 1 March 2020 and 14 November 2022. Probable or proven CAPA was diagnosed according to the 2020 European Confederation for Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) criteria. Results We included 335 patients. Bronchoalveolar lavage sampling was performed in 300 (90%), and CAPA was diagnosed in 112 (33%). The incidence of CAPA was 62% (50 of 81 patients) in European Organisation for Research and Treatment of Cancer (EORTC)/Mycosis Study Group Education and Research Consortium (MSGERC) host factor–positive patients, compared with 24% (62 of 254) in host factor–negative patients. The incidence of CAPA was significantly higher in the vaccination era, increasing from 24% (57 of 241) in patients admitted to the ICU before October 2021 to 59% (55 of 94) in those admitted since then. Both EORTC/MSGERC host factors and ICU admission in the vaccination era were independently associated with CAPA development. CAPA remained an independent risk factor associated with mortality risk during the vaccination era. Conclusions The presence of EORTC/MSGERC host factors for invasive mold disease is associated with increased CAPA incidence and worse outcome parameters, and it is the main driver for the significantly higher incidence of CAPA in the vaccination era. Our findings warrant investigation of antifungal prophylaxis in critically ill patients with COVID-19. [ABSTRACT FROM AUTHOR]