COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave

Bretagne, Stéphane; Sitbon, Karine; Botterel, Françoise; Dellière, Sarah; Letscher-Bru, Valérie; Chouaki, Taïeb; Bellanger, Anne‐Pauline; Bonnal, Christine; Fekkar, Arnault; Persat, Florence; Costa, Damien; Bourgeois, Nathalie; Dalle, Frédéric; Lussac-Sorton, Florian; Paugam, A.; Cassaing, Sophie; Hasseine, Lilia; Huguenin, A; Guennouni, Nadia; Mazars, Edith; Gal, Solène Le; Sasso, Milène; Brun, Sophie; Cadot, Lucile; Cassagne, Carole; Cateau, Estelle; Gangneux, Jean‐Pierre; Moniot, Maxime; Roux, Anne-Laure; Tournus, Céline; Desbois‐Nogard, Nicole; Coustumier, Alain Le; Moquet, Olivier; Alanio, Alexandre; Dromer, Françoise

doi:10.1128/spectrum.01138-21

Cited by 36 publications

(32 citation statements)

References 47 publications

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“…Of 135 screened patients, 16 had multiple Aspergillus criteria, while 23 had a single criterion, but mortality was not mentioned for either group. Although the number of positive criteria would reflect fungal burden, which was already suggested in immunocompromised IPA patients ( 24 ) and recently also observed in CAPA patient with no known risk factors ( 25 ), combining criteria could help overcome false-positive issues and overdiagnosis of CAPA. Reflecting most probably higher fungal loads, positive direct examination, positive serum GM and Af -qPCR should be included in a future algorithm as criteria with higher weighting coefficient ( Fig.…”

Section: Discussionmentioning

confidence: 97%

Combination of Mycological Criteria: a Better Surrogate to Identify COVID-19-Associated Pulmonary Aspergillosis Patients and Evaluate Prognosis?

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Introduction: Diagnosis of COVID-19 associated pulmonary aspergillosis remains unclear especially in non-immunocompromised patients. The aim of this study was to evaluate seven mycological criteria and their combination in a large homogenous cohort of patients. Methods: All successive patients (n=176) hospitalized for COVID-19 requiring mechanical ventilation and who clinically worsened despite appropriate standard of care were included over a one-year period. Direct examination, culture, Aspergillus qPCR ( Af -qPCR) and galactomannan was performed on all respiratory samples (n=350). Serum galactomannan, ß-D-glucan and plasma Af -qPCR were also assessed. Criteria were analyzed alone or in combination in relation to mortality rate. Results: Mortality was significantly different in patients with 0, ≤2 and ≥3 positive criteria (logrank test, p=0.04) with death rate of 43.1, 58.1 and 76.4% respectively. Direct examination, plasma qPCR and serum galactomannan were associated with a 100% mortality rate. Bronchoalveolar lavage (BAL) galactomannan and positive respiratory sample culture were often found as isolated markers (28.1 and 34.1%) and poorly repeatable when a second sample was obtained. Aspergillus DNA was detected in 13.1% of samples (46/350) with significantly lower Cq when associated with at least one other criteria (30.2 vs 35.8) (p<0.001). Conclusion: Combination of markers and/or blood biomarkers and/or direct respiratory sample examination seems more likely to identify patients with CAPA. Af -qPCR may help identifying false positive results of BAL galactomannan testing and culture on respiratory samples while quantifying fungal burden accurately.

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Section: Discussionmentioning

confidence: 97%

Combination of Mycological Criteria: a Better Surrogate to Identify COVID-19-Associated Pulmonary Aspergillosis Patients and Evaluate Prognosis?

et al. 2022

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“…A large case-level analysis has similar results showing that median number of days since detection of candidemia and admission to normal ward was 14 days ( 27 ). In another study, candidemia was diagnosed at a median time of 16 days after ICU admission ( 28 ). Here, only BC was used, which could explain the longer time until detection compared to our cohort.…”

Section: Discussionmentioning

confidence: 99%

Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19

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“…Interactions with our colleagues and SPF permit uncovering such cases. Altogether the e-CRF flexibility and interactions with SPF allowed to rapidly evaluate the Saprochaete clavata outbreak in 2012 ( 38 ), to assess the small number of Candida auris in France ( 12 ), or more recently to investigate the burden of IFDs in the context of COVID-19 ( 39 ). The e-CRF is indeed easily amendable through the VOOZANOO platform to record new parameters (e.g., COVID-19 context).…”

Section: Discussionmentioning

confidence: 99%

Active Surveillance Program to Increase Awareness on Invasive Fungal Diseases: the French RESSIF Network (2012 to 2018)

Bretagne

Sitbon

Desnos‐Ollivier

et al. 2022

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COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave

Cited by 36 publications

References 47 publications

Combination of Mycological Criteria: a Better Surrogate to Identify COVID-19-Associated Pulmonary Aspergillosis Patients and Evaluate Prognosis?

Combination of Mycological Criteria: a Better Surrogate to Identify COVID-19-Associated Pulmonary Aspergillosis Patients and Evaluate Prognosis?

Rapid Detection of Bacterial and Fungal Pathogens Using the T2MR versus Blood Culture in Patients with Severe COVID-19

Active Surveillance Program to Increase Awareness on Invasive Fungal Diseases: the French RESSIF Network (2012 to 2018)

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