Τίτλος:
Epidemiology and Incidence of COVID-19-Associated Pulmonary
Aspergillosis (CAPA) in a Greek Tertiary Care Academic Reference
Hospital
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Introduction Invasive pulmonary aspergillosis is an emerging
complication among intensive care unit (ICU) patients with COVID-19
(CAPA). In the present study, all CAPA cases during the first year of
the pandemic were reviewed in critically ill patients at a 650-bed
tertiary Greek COVID-19 reference hospital. Methods Data regarding
patients admitted to the ICU of Attikon Hospital in Athens, Greece,
between 22 March 2020 and 28 February 2021 with a positive PCR for
SARS-CoV-2 infection were reviewed. Clinical and microbiological records
were analysed including demographic, clinical, laboratory and
radiological features, treatment and outcomes. CAPA was determined
according to the recent 2020 ECMM/ISHAM definitions. Results A total of
179 patients were admitted in the ICU and 6 (3.3%) patients were
diagnosed with CAPA (4 probable and 2 possible CAPA) with 5/6 with
co-infection with multidrug-resistant (MDR) gram-negative pathogens. No
patient had a history of immunosuppression. All suffered from acute
respiratory distress syndrome. The median (range) time from intubation
to diagnosis was 6 (1-14) days. Five patients had positive Aspergillus
cultures in bronchial secretions (1 A. fumigatus, 1 A. flavus, 1 A.
fumigatus + A. flavus, 1 A. fumigatus + A. terreus and 1 A. terreus)
while culture was negative in one patient. All isolates were susceptible
to antifungal drugs. Serum galactomannan (GM), pan-Aspergillus PCR and
(1,3)-beta-d-glucan (BDG) were positive in 4/6 (67%), 5/6 (83%, 3/5 in
two consecutive samples) and 4/6 (67%, in consecutive samples)
patients, respectively. GM and PCR positive bronchial secretions had GM
indices > 9.95 and PCR C-t < 34. All were treated with antifungal drugs
with 5 out of 6 receiving isavuconazole. Mortality was 67% (4/6) with
1/4 attributed to CAPA (two died as a result of bacterial septic shock
and one as a result of multiorgan failure). Conclusion The incidence of
CAPA in ICU patients was 3.3% and it was associated with approximately
a 17% attributable mortality in the setting of MDR gram-negative
pathogen co-infections.
Συγγραφείς:
Paramythiotou, Elisabeth
Dimopoulos, George
Koliakos, Nikolaos
and Siopi, Maria
Vourli, Sophia
Pournaras, Spyros and
Meletiadis, Joseph
Περιοδικό:
Infectious Diseases and Therapy
Εκδότης:
Springer-Verlag London Ltd
Λέξεις-κλειδιά:
Aspergillosis; COVID-19; ARDS; Lung infection; MDR gram-negative
co-infections
DOI:
10.1007/s40121-021-00486-8
