A screening study for COVID‐19‐associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic

Abstract

Background COVID‐19‐associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves. Objectives We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic. Patients/Methods This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID‐19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS‐CoV‐2 PCR‐positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases. Results A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001). Conclusions One fifth of critically ill patients in COVID‐19 ICUs developed CAPA, and this was associated with a high mortality.

Comparison of risk factors and outcome of patients with and without COVID‐19‐associated pulmonary aspergillosis from Pakistan: A case–control study

“…Among risk factors for CAPA, we found an independent association with critical COVID‐19 at presentation (89% vs. 57%), particularly those requiring invasive mechanical ventilation (56%). This was similarly reported from study done in Turkey 14 . Findings from a multicentre study from Korea reported significant association between critical COVID‐19 and mechanical ventilation with CAPA on univariate analysis but was not found to be predictive of CAPA 15 .…”

“…23 Mortality in patients with CAPA was 48%, and it was significantly higher compared to those patients without CAPA (13%). This has been similarly reported from Europe (58% vs.24.1%), Turkey (ICU mortality of 67.4% vs. 29.4%) 14 as well as systematic reviews of studies largely conducted in high-income countries. 17,20,24,25 However, despite higher mortality with CAPA in COVID-19 patients in Brazil, no significant difference was observed in comparison with non-CAPA patients.…”

“…This was similarly reported from study done in Turkey. 14 Findings from a multicentre study from Korea reported significant association between critical COVID‐19 and mechanical ventilation with CAPA on univariate analysis but was not found to be predictive of CAPA. 15 A French multicentre study reported no association of probable IPA with severity of COVID‐19 at presentation as well as mechanical ventilation when compared to patients without IPA in ICU setting.…”

Active screening of COVID‐19‐associated pulmonary aspergillosis with serum beta‐glucan and endotracheal aspirates galactomannan and fungal culture

“…In contrast with most of the previous CAPA case series reported in the literature, 8–10 we performed a higher number of chest CT scans and found a surprisingly high incidence of typical radiological signs of invasive aspergillosis. Recently, a study reported to have found 3 cases with cavitations out of 17 chest CT scans 11 . Even if we have no histologically proven cases, combining the presence of microbiological criteria with the presence of air crescent sign and/or cavitations gives strength to our CAPA diagnosis.…”

“…Recently, a study reported to have found 3 cases with cavitations out of 17 chest CT scans. 11 Even if we have no histologically proven cases, combining the presence of microbiological criteria with the presence of air crescent sign and/ or cavitations gives strength to our CAPA diagnosis. In our population, we found no mortality difference in patients with CAPA who had no radiological signs and received 6 weeks of voriconazole, while highest mortality despite treatment was seen in patients with classical radiological signs of invasive aspergillosis (50% vs 22%).…”