Journal
CLINICAL MICROBIOLOGY AND INFECTION
Volume 28, Issue 4, Pages 580-587Publisher
ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2021.08.014
Keywords
Aspergillus; Coronavirus disease 2019; Coronavirus disease 2019-associated pulmonary aspergillosis; Intensive care unit; Survival
Categories
Funding
- NIHR Manchester Biomedical Research Centre
- German Federal Ministry of Research and Education and the State of North Rhine-Westphalia, Germany
- NIH [UL1TR001442]
- Gilead
- Pfizer
- Astellas
Ask authors/readers for more resources
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a common complication among critically ill COVID-19 patients in ICU. It is more prevalent in older patients, those receiving invasive ventilation, and those receiving tocilizumab treatment. CAPA is an independent predictor of ICU mortality.
Objectives: Coronavirus disease 2019 (COVID-19) -associated pulmonary aspergillosis (CAPA) has emerged as a complication in critically ill COVID-19 patients. The objectives of this multinational study were to determine the prevalence of CAPA in patients with COVID-19 in intensive care units (ICU) and to investigate risk factors for CAPA as well as outcome. Methods: The European Confederation of Medical Mycology (ECMM) conducted a multinational study including 20 centres from nine countries to assess epidemiology, risk factors and outcome of CAPA. CAPA was defined according to the 2020 ECMM/ISHAM consensus definitions. Results: A total of 592 patients were included in this study, including 11 (1.9%) patients with histologically proven CAPA, 80 (13.5%) with probable CAPA, 18 (3%) with possible CAPA and 483 (81.6%) without CAPA. CAPA was diagnosed a median of 8 days (range 0-31 days) after ICU admission predominantly in older patients (adjusted hazard ratio (aHR) 1.04 per year; 95% CI 1.02-1.06) with any form of invasive respiratory support (HR 3.4; 95% CI 1.84-6.25) and receiving tocilizumab (HR 2.45; 95% CI 1.41-4.25). Median prevalence of CAPA per centre was 10.7% (range 1.7%-26.8%). CAPA was associated with significantly lower 90-day ICU survival rate (29% in patients with CAPA versus 57% in patients without CAPA; Mantel-Byar p < 0.001) and remained an independent negative prognostic variable after adjusting for other predictors of survival (HR 2.14; 95% CI 1.59-2.87, p <= 0.001). Conclusion: Prevalence of CAPA varied between centres. CAPA was significantly more prevalent among older patients, patients receiving invasive ventilation and patients receiving tocilizumab, and was an independent strong predictor of ICU mortality. (C) 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available