Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU

Fekkar, Arnaud; Lampros, Alexandre; Mayaux, Julien; Poignon, Corentin; Demeret, Sophie; Constantin, Jean-Michel; Marcelin, Anne‐Geneviève; Monsel, Antoine; Luyt, Charles‐Édouard; Blaize, Marion

doi:10.1164/rccm.202009-3400oc

Cited by 144 publications

(199 citation statements)

References 33 publications

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“…Although IAPA is a well-recognized clinical entity, data regarding the association between IPA and COVID-19 are still conflicting [42][43][44][45][46]. Overall, we found a lower prevalence of CAPA (3.6%) than that reported so far, which ranged from 3.3 to 33.3% of ICU subjects with COVID-19, with a recent review of the literature reporting a total of 93 ICU patients who developed IPA after a mean ICU stay of 7 days [27].…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

et al. 2021

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Background Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). Materials/methods Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. Results Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58–76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). Conclusions In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

et al. 2021

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“…Out of the 28 observational studies, 14.3% (4/28) of studies had no descriptions of the specific bacterial or fungal microorganisms identified (Table 2). The most common bacterial microorganisms identified in the respiratory tract cultures among the nine observational studies (Table 2 [17]. Other rare opportunistic fungal infections such as Pneumocystis jirovecii (PJP) had been observed in four case reports/series included in our review [18][19][20][21].…”

Section: Microbiology Of Secondary Pulmonary Infectionsmentioning

confidence: 97%

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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“…Coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome virus 2 (SARS-CoV-2), has affected more than 130 million people worldwide, accounting for over 2.8 million deaths on the day of this report. Although aspergillosis has been reported to complicate severe COVID-19 (the entity is coined COVID-19-associated aspergillosis or CAPA), the pathophysiology and the true incidence of CAPA remains debatable, as very few CAPA cases are biopsy-documented [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

John

Jacob

Kontoyiannis

2021

JoF

372

352

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Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU

Cited by 144 publications

References 33 publications

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission

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

When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

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