Elevated Rates of Ventilator-Associated Pneumonia and COVID-19 Associated Pulmonary Aspergillosis in Critically Ill Patients with SARS-CoV2 Infection in the Second Wave: A Retrospective Chart Review

Abstract

Due to multiple risk factors, the rate of ventilator-associated pneumonia in critically ill COVID-19 patients has been reported in a range of 7.6% to 86%. The rate of invasive pulmonary aspergillosis in this cohort has been reported at 4% to 30%. We undertook a retrospective chart review of 276 patients who were admitted to intensive care in a large university hospital. The period studied included patients from 23 February 2014 to 12 May 2021. Four groups were collected: COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia. Clinical characteristics, outcomes, and microbiological cultures were recorded. The incidence of ventilator-associated pneumonia in COVID-19 Wave 1, COVID-19 Wave 2, influenza, and community-acquired pneumonia was 5.45%, 27.40%, 16.67%, and 3.41%, respectively (p < 0.001). The rate of invasive pulmonary aspergillosis was 0%, 9.59%, 13.33%, and 6.82%, respectively (p < 0.001). A significantly elevated rate of ventilator-associated pneumonia and invasive pulmonary aspergillosis was noted in the second wave of COVID-19 when compared to the first. This was accompanied by an increase in the mortality rate. Increased steroid use was an independent risk factor for ventilator-associated pneumonia and invasive pulmonary aspergillosis across all four groups. Despite an increased understanding of this disease, no clinical trials have shown any promising therapeutic options at present.

Microbiological diagnosis of pulmonary invasive aspergillosis in critically ill patients with severe SARS-CoV-2 pneumonia: a bronchoalveolar study

“…In this study, we used a combination of two or more microbiological markers for diagnosis. The incidence of CAPA in this prospective cohort of 160 patients was 18.75%, which is similar to that found in several studies [ 18 , 19 ]. By applying the 2020 ECMM/ISHAM consensus criteria however, the incidence in this study would have been 24.4% (n = 39).…”

Case report: Evolution of pulmonary manifestations and virological markers in critical COVID-19 infection in Bruton’s agammaglobulinemia

“…Moreover, empirical voriconazole was administered to cover a possible Aspergillus spp. co-infection, which was suspected due to the high dose dexamethasone treatment previously reported to increase the risk of infection with Aspergillus spp.in critically ill COVID-19 patients in the ICU patients ( 6 ). The following day his condition further deteriorated with increased need for oxygen therapy (10 L/min).…”

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

“… 17 Most studies exploring CAPA risk factors have either included all intubated patients or critically ill patients, hence excluding possibility of analysing this as a risk factor for CAPA. 18 , 19 …”

“…A recently published systematic review and meta‐analysis reported that based on sequential organ failure assessment score, CAPA patients had comparatively greater severity of illness at presentation 17 . Most studies exploring CAPA risk factors have either included all intubated patients or critically ill patients, hence excluding possibility of analysing this as a risk factor for CAPA 18,19 …”