Invasive Aspergillosis associated with Covid-19: A word of caution

Gouzien, Laura; Cocherie, Théophile; Éloy, O.; Legriel, Stéphane; Bédos, Jean‐Pierre; Simon, C.; Marque-Juillet, Stéphanie; Ferré, Alexis; Bruneel, Fabrice

doi:10.1016/j.idnow.2020.12.008

Cited by 14 publications

(17 citation statements)

References 14 publications

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“…Meanwhile, the median time to develop CAPA among patients with COVID-19 who received mechanical ventilation was 7.28 days. Studies reported that the incidence of CAPA varied from 1.9-27.7% [14,43,45]. This wide divergence might result an underestimate of the risk of CAPA.…”

Section: Discussionmentioning

confidence: 99%

“…Mycology, and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria. However, the exact incidence of CAPA remains unknown and opinions are polarized [13][14][15][16]. Currently, reports on the incidence, risk factors, and outcomes of CAPA remain inconclusive.…”

Section: Respiratory Viruses (Includingmentioning

confidence: 99%

“…Of the 29 studies, (27.59%) were from France [2,13,[21][22][23][24][25][26]], 4 (13.79%) were from the United Kingdom (UK) [27][28][29][30][31][32], 4 (13.79%) were from the Netherlands [33,34], 2 (6.90%) were from Germany [35,36], 2 (6.90%) were from Spain [15,37], 2 (6.90%) were from Switzerland [14,38], 1 (3.45%) was from the USA [39], 1 (3.45%) was from Belgium [40], 1 (3.45%) was from China[6], 1(3.45%) was from Pakistan [41], 1(3.45%) was from Denmark [42], 1 (3.45%) was from Italy [43] and 1(3.45%) from Mexico [44]. Twelve studies dealt with patients who received mechanical ventilation, eight studies were of patients with ARDS, one study was on extracorporeal membrane oxygenation (ECMO), 1 study looked at acute respiratory failure (ARF), and seven studies included other patients with severe COVID-19 (See additional le 1, supplementary 1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…A diagnosis of CAPA was made based on speci c case de nitions or diagnostic algorithms, including the AspICU algorithm, Modi ed AspICU algorithm, in uenza-associated pulmonary aspergillosis (IAPA) criteria, the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group, the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG), the European Confederation for MedicalMycology, and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria. However, the exact incidence of CAPA remains unknown and opinions are polarized [13][14][15][16]. Currently, reports on the incidence, risk factors, and outcomes of CAPA remain inconclusive.…”

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confidence: 99%

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Incidence, Risk Factors, and Outcomes of Patients with COVID‑19‑Associated Pulmonary Aspergillosis (CAPA) in Intensive Care Units: A Systematic Review and Meta-Analysis Of 29 Cohort Studies

Chen¹,

Yin

Ming

et al. 2021

Preprint

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Background Patients with Coronavirus disease 2019 (COVID-19) admitted to an intensive care unit (ICU) might develop COVID-19-related pulmonary Aspergillosis (CAPA). We aimed to identify studies systematically that describe the incidence and risks factors of CAPA, and to assess its outcome. Methods Two authors independently searched ScienceDirect, PubMed, CNKI, MEDLINE (OVID), and MedRXIV from December 31, 2019 to Feb 27, 2021. We included observational cohort studies that investigated patients with CAPA admitted to an ICU. We assessed the quality of all included studies using the Newcastle–Ottawa Scale). The meta-analysis was registered with PROSPERO (CRD42021242179).ResultsTwenty-nine cohort studies with 2095 patients with COVID-19 admitted to an ICU and 264 patients who developed to CAPA were included (Pooled incidence: 0.14, 95% confidence interval [CI] = 0.11–0.17). The overall mortality and case fatality rate of CAPA were 0.07 (0.05–0.09) and 0.51 (0.44–0.58), respectively. Patients with COVID‑19 would develop CAPA at 7.28 days after mechanical ventilation (range, 5.48–9.08). Compared with patients without CAPA, those with CAPA had a significantly lower median body mass index (27.32 vs. 28.97 kg/m2, P = 0.034), higher median creatinine level (127.94 vs. 88.23 µmol/L, P = 014), and were more likely to receive corticosteroids therapy (41.0% vs. 38.0%, risk ratio [RR] = 1.98, 95% CI=1.08–3.63) and renal replacement therapy (42.0% vs. 28.2%, RR = 1.61, 95% CI=1.04–2.50) during admission. Remarkably, patients with CAPA were associated significantly with a 1.66‑fold higher mortality (RR = 1.66, 95% CI=1.31–2.12) without significant heterogeneity and publication bias. ConclusionsPatients with COVID-19 admitted to an ICU might develop CAPA and have higher all‑cause mortality. We recommend conducting prospective screening for CAPA among patients with severe COVID-19, especially for those who receive mechanical ventilation over 7 days.

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Section: Discussionmentioning

confidence: 99%

Section: Respiratory Viruses (Includingmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Incidence, Risk Factors, and Outcomes of Patients with COVID‑19‑Associated Pulmonary Aspergillosis (CAPA) in Intensive Care Units: A Systematic Review and Meta-Analysis Of 29 Cohort Studies

Chen¹,

Yin

Ming

et al. 2021

Preprint

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“…among others [88][89][90][91][92]. The importance of appropriate case definitions for infection is underscored [91,93]. Unique co-infections with atypical or chronic bacterial infections (in addition to M. pneumoniae as previously discussed) have also been cited [94][95][96][97][98][99][100].…”

Section: Co-detection Of Sars-cov-2 With Selected Non-viral Infections and Chronic Viral Infectionsmentioning

confidence: 99%

The Complexity of Co-Infections in the Era of COVID-19

Cimolai

2021

SN Compr. Clin. Med.

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COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles

et al. 2023

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Among the co-infectious agents in COVID-19 patients, Aspergillus species cause invasive pulmonary aspergillosis (IPA). IPA is difficult to diagnose and is associated with high morbidity and mortality. This study is aimed at identifying Aspergillus spp. from sputum and tracheal aspirate (TA) samples of COVID-19 patients and at determining their antifungal susceptibility profiles. A total of 50 patients with COVID-19 hospitalized in their intensive care units (ICU) were included in the study. Identification of Aspergillus isolates was performed by phenotypic and molecular methods. ECMM/ISHAM consensus criteria were used for IPA case definitions. The antifungal susceptibility profiles of isolates were determined by the microdilution method. Aspergillus spp. was detected in 35 (70%) of the clinical samples. Among the Aspergillus spp., 20 (57.1%) A. fumigatus , six (17.1%) A. flavus , four (11.4%) A. niger , three (8.6%) A. terreus , and two (5.7%) A. welwitschiae were identified. In general, Aspergillus isolates were susceptible to the tested antifungal agents. In the study, nine patients were diagnosed with possible IPA, 11 patients were diagnosed with probable IPA, and 15 patients were diagnosed with Aspergillus colonization according to the used algorithms. Serum galactomannan antigen positivity was found in 11 of the patients diagnosed with IPA. Our results provide data on the incidence of IPA, identification of Aspergillus spp., and its susceptibility profiles in critically ill COVID-19 patients. Prospective studies are needed for a faster diagnosis or antifungal prophylaxis to manage the poor prognosis of IPA and reduce the risk of mortality.

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Invasive Aspergillosis associated with Covid-19: A word of caution

Cited by 14 publications

References 14 publications

Incidence, Risk Factors, and Outcomes of Patients with COVID‑19‑Associated Pulmonary Aspergillosis (CAPA) in Intensive Care Units: A Systematic Review and Meta-Analysis Of 29 Cohort Studies

Incidence, Risk Factors, and Outcomes of Patients with COVID‑19‑Associated Pulmonary Aspergillosis (CAPA) in Intensive Care Units: A Systematic Review and Meta-Analysis Of 29 Cohort Studies

The Complexity of Co-Infections in the Era of COVID-19

COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles

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