Pulmonary Aspergillosis in Critically Ill COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Bergmann, Felix; Jorda, Anselm; Blaschke, Amelie; Gabler, Cornelia; Bohdan, Serhii; Nussbaumer‐Pröll, Alina; Radtke, Christine; Zeitlinger, Markus

doi:10.3390/jof9030315

Cited by 7 publications

(6 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Their analysis included critically ill cases and those with mixed populations. The proportion of fungal coinfections was reported, and the mortality rate associated with fungal coinfections and COVID-19 was determined (25,51,55). The overall mortality rate was found to be 10.9%.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with COVID-19 and Fungal Coinfections: A Systematic Review and Meta-Analysis Study

Khodavaisy,

Sarrafnia,

Abdollahi

2024

Iran J Pathol

View full text Add to dashboard Cite

Background & Objective: Fungal co-infections increase the incidence and mortality of viral respiratory tract infections. This study systematically reviews and conducts a meta-analysis to evaluate the prevalence of COVID-19 patients with fungal coinfections. The aim is to provide a concise overview of the impact of these infections on patient outcomes especially association with risk of mortality, informing future research and optimizing patient management strategies. Methods: To identify relevant studies on COVID-19 patients, we conducted a systematic search of databases from the beginning of the year until July 2023, including fungal co-infections, mortality, and sequelae. Eligibility criteria were developed using the PICO framework, and data extraction was carried out separately by two authors using standard techniques. Statistical analysis was performed using the correlation model and differences between studies were evaluated using the I2 test. R and RStudio were used for statistical analysis and visualization. Results: We initially identified 6,764 studies, and after checking for equivalence and consistency, 41 studies were included in the final analysis. The overall COVID-19 odds ratio for people who died from fungal infections was 2.65, indicating that patients infected with both COVID-19 and fungal infections had a higher risk of death compared to patients with COVID-19 alone. Specifically, COVID-19-associated pulmonary aspergillosis (CAPA) has a higher odds ratio of 3.36, while COVID-19-associated candidiasis (CAC) has an odds ratio of 1.84, and both are much more associated with death. However, coinfection of the fungus with other fungal species did not show a significant difference in the risk of mortality. Conclusion: This study identified CAPA and CAC as the most common infections acquired in healthcare settings. Fungal coinfections may be associated with an increased risk of death in COVID-19 patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcomes of Patients with COVID-19 and Fungal Coinfections: A Systematic Review and Meta-Analysis Study

Khodavaisy,

Sarrafnia,

Abdollahi

2024

Iran J Pathol

View full text Add to dashboard Cite

show abstract

“…CAPA onset is more delayed compared to IAPA; usually, the onset is >7 days from ICU admission (median 8 days, IQR 5–15), although a study that used a strategy of performing a BAL directly after admission reported an earlier onset (4 days) [5,44 ▪▪ ,49,50 ▪▪ ,51,52 ▪▪ ]. It should be highlighted though, that the true prevalence of CAPA and the timing of onset remains to be further defined, as most studies relied on diagnostic work up either on deteriorating patients or on positive upper respiratory tract cultures [5,44 ▪▪ ].…”

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

“…Compared with COVID-19 cases that are not complicated by IPA, CAPA is associated with worse outcomes overall, as well as in the subgroup of patients requiring extracorporeal oxygenation (ECMO) [5,49,50 ▪▪ ,51]. The mortality of CAPA is high, but with a wide reported range, from 36% to 74% [5,49,50 ▪▪ ,51]. The attributable mortality of CAPA is not fully elucidated [45 ▪▪ ].…”

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile

Koulenti,

Papathanakos,

Blot

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

Purpose of review In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades. Recent findings In the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily. Acute viral infection by influenza or SARS-Cov-2 are now well recognized risk factors for IPA. Summary The classic risk profile (‘host factors’) reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.

show abstract

“… 2 Aspergillosis poses a significant public health threat, especially among immunocompromised individuals and patients receiving intensive care, with mortality rates surpassing 50%. 3–5 …”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics of isavuconazole at different target sites in healthy volunteers after single and multiple intravenous infusions

Bergmann,

Wölfl-Duchek,

Jorda

et al. 2024

Journal of Antimicrobial Chemotherapy

Self Cite

View full text Add to dashboard Cite

Background Invasive aspergillosis is a severe fungal infection that affects multiple organ systems including the CNS and the lungs. Isavuconazole, a novel triazole antifungal agent, has demonstrated promising activity against Aspergillus spp. However, data on the penetration of isavuconazole into the CNS and ELF and intracellular accumulation remain limited. Materials and methods We conducted a prospective single-centre pharmacokinetic (PK) study in 12 healthy volunteers. Subjects received seven doses of 200 mg isavuconazole to achieve an assumed steady-state. After the first and final infusion, plasma sampling was conducted over 8 and 12 h, respectively. All subjects underwent one lumbar puncture and bronchoalveolar lavage, at either 2, 6 or 12 h post-infusion of the final dose. PBMCs were collected in six subjects from blood to determine intracellular isavuconazole concentrations at 6, 8 or 12 h. The AUC/MIC was calculated for an MIC value of 1 mg/L, which marks the EUCAST susceptibility breakpoint for Aspergillus fumigatus and Aspergillus flavus. Results C max and AUC0-24h of isavuconazole in plasma under assumed steady-state conditions were 6.57 ± 1.68 mg/L (mean ± SD) and 106 ± 32.1 h·mg/L, respectively. The average concentrations measured in CSF, ELF and in PBMCs were 0.07 ± 0.03, 0.94 ± 0.46 and 27.1 ± 17.8 mg/L, respectively. The AUC/MIC in plasma, CSF, ELF and in PBMCs under steady-state conditions were 106 ± 32.1, 1.68 ± 0.72, 22.6 ± 11.0 and 650 ± 426 mg·h/L, respectively. Conclusion Isavuconazole demonstrated moderate penetration into ELF, low penetrability into CSF and high accumulation in PBMCs. Current dosing regimens resulted in sufficient plasma exposure in all subjects to treat isolates with MICs ≤ 1 mg/L.

show abstract

Pulmonary Aspergillosis in Critically Ill COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Cited by 7 publications

References 32 publications

Outcomes of Patients with COVID-19 and Fungal Coinfections: A Systematic Review and Meta-Analysis Study

Outcomes of Patients with COVID-19 and Fungal Coinfections: A Systematic Review and Meta-Analysis Study

Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile

Pharmacokinetics of isavuconazole at different target sites in healthy volunteers after single and multiple intravenous infusions

Contact Info

Product

Resources

About