Bronchoscopy on Intubated Patients with COVID-19 Is Associated with Low Infectious Risk to Operators

Gao, Catherine; Bailey, Joseph; Walter, James M.; Coleman, John M.; Malsin, E.; Argento, A. Christine; Prickett, Michelle; Wunderink, Richard G.; Smith, Sean B.

doi:10.1513/annalsats.202009-1225rl

Cited by 46 publications

(46 citation statements)

References 20 publications

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“…Locally, we run a large pleural unit with high rates of lung cancer and mesothelioma and provide a regional interventional service. 3 As per known literature, we have noticed a dramatic drop in referrals. New patient referrals to pleural clinic for any cause in 2020 were only 43% compared to 2019 numbers (unpublished local data) (clinics were kept open during the pandemic as multi-site working is possible locally) and we also noted a drop in interventions performed (57 in 2020 vs 97 in 2019, even allowing for 6 weeks where no elective theatre lists ran).…”

Section: A Note On Lung Cancer In the Covid-19 Erasupporting

confidence: 56%

“…2 Subsequently, it has been shown that, when indicated, bronchoscopy can be performed safely in those with COVID-19. 3 Data from our centre indicate that bronchoscopy can be undertaken for multiple indications when there is careful adherence to PPE use, enabling continuation of essential services, particularly in the aforementioned timely diagnosis of lung cancer. 4 St Vincent's University Hospital, an 836-bed academic health centre in Dublin, Ireland, is one of the eight designated national cancer centres which provides rapid access diagnostic and treatment options for the management of suspected lung cancer.…”

Section: To the Editorsmentioning

confidence: 97%

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Provision of essential bronchoscopy during COVID‐19 pandemic

et al. 2021

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Section: A Note On Lung Cancer In the Covid-19 Erasupporting

confidence: 56%

Section: To the Editorsmentioning

confidence: 97%

Provision of essential bronchoscopy during COVID‐19 pandemic

et al. 2021

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“…The use of bronchoscopy in COVID-19 patients has been recommended when current respiratory samples from sputum and endotracheal aspirates are negative, in which an alternate diagnosis provided by BAL would significantly impact clinical management [44]. Nevertheless, two recent single-center retrospective studies showed no increase in the risk of COVID-19 transmission to healthcare providers when bronchoscopy is routinely performed while adhering to the proper infection control protocol [12,45].…”

Section: Discussionmentioning

confidence: 99%

State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia

et al. 2021

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Background The incidence of secondary pulmonary infections is not well described in hospitalized COVID-19 patients. Understanding the incidence of secondary pulmonary infections and the associated bacterial and fungal microorganisms identified can improve patient outcomes. Objective This narrative review aims to determine the incidence of secondary bacterial and fungal pulmonary infections in hospitalized COVID-19 patients, and describe the bacterial and fungal microorganisms identified. Method We perform a literature search and select articles with confirmed diagnoses of secondary bacterial and fungal pulmonary infections that occur 48 h after admission, using respiratory tract cultures in hospitalized adult COVID-19 patients. We exclude articles involving co-infections defined as infections diagnosed at the time of admission by non-SARS-CoV-2 viruses, bacteria, and fungal microorganisms. Results The incidence of secondary pulmonary infections is low at 16% (4.8-42.8%) for bacterial infections and lower for fungal infections at 6.3% (0.9-33.3%) in hospitalized COVID-19 patients. Secondary pulmonary infections are predominantly seen in critically ill hospitalized COVID-19 patients. The most common bacterial microorganisms identified in the respiratory tract cultures are Pseudomonas aeruginosa, Klebsiella species, Staphylococcus aureus, Escherichia coli, and Stenotrophomonas maltophilia. Aspergillus fumigatus is the most common microorganism identified to cause secondary fungal pulmonary infections. Other rare opportunistic infection reported such as PJP is mostly confined to small case series and case reports. The overall time to diagnose secondary bacterial and fungal pulmonary infections is 10 days (2-21 days) from initial hospitalization and 9 days (4-18 days) after ICU admission. The use of antibiotics is high at 60-100% involving the studies included in our review. Conclusion The widespread use of empirical antibiotics during the current pandemic may contribute to the development of multidrug-resistant microorganisms, and antimicrobial stewardship programs are required for minimizing and de-escalating antibiotics. Due to the variation in definition across most studies, a large, well-designed study is required to determine the incidence, risk factors, and outcomes of secondary pulmonary infections in hospitalized COVID-19 patients.

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“…Furthermore, during the first wave of the COVID-19 pandemic, bronchoscopic explorations were considered as a source of exposure to SARS-CoV-2 for physicians due to the risk of the aerosolization during this procedure. Thus, we performed such investigations less frequently in COVID-19 patients; this risk has been debunked in recent papers [ 35 ]. Hence, it was not always possible to identify bronchoscopic findings suggestive of Aspergillus tracheobronchitis, such as epithelial plaques, pseudomembranes, or ulcers.…”

Section: Discussionmentioning

confidence: 99%

Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different?

Reizine

Pinceaux

Léderlin

et al. 2021

JoF

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Invasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern. Influenza-associated acute respiratory distress syndrome (ARDS) and severe COVID-19 patients are both at risk of developing invasive fungal diseases. We used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological, and radiological aspects of IAPA and CAPA in a monocentric retrospective study. A total of 120 patients were included, 71 with influenza and 49 with COVID-19-associated ARDS. Among them, 27 fulfilled the newly published criteria of IPA: 17/71 IAPA (23.9%) and 10/49 CAPA (20.4%). Kaplan–Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0.032), whereas mortality did not differ between CAPA and IAPA patients. Radiological findings showed differences between IAPA and CAPA, with a higher proportion of features suggestive of IPA during IAPA. Lastly, a wide proportion of IPA patients had low plasma voriconazole concentrations with a higher delay to reach concentrations > 2 mg/L in CAPA vs. IAPA patients (p = 0.045). Severe COVID-19 and influenza patients appeared very similar in terms of prevalence of IPA and outcome. The dramatic consequences on the patients’ prognosis emphasize the need for a better awareness in these particular populations.

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Bronchoscopy on Intubated Patients with COVID-19 Is Associated with Low Infectious Risk to Operators

Cited by 46 publications

References 20 publications

Provision of essential bronchoscopy during COVID‐19 pandemic

Provision of essential bronchoscopy during COVID‐19 pandemic

State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia

Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different?

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