Pulmonary Aspergillosis in Patients with Suspected Ventilator-associated Pneumonia in UK ICUs

Loughlin, Laura; Hellyer, Thomas P; White, P. Lewis; Morris, Andrew Conway; Posso, Raquel; Denning, David W.; Simpson, A. John; McMullan, Ronan

doi:10.1164/rccm.202002-0355oc

Cited by 43 publications

(62 citation statements)

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“…There is increasing recognition of fungal infections amongst patients with viral pneumonitides and VAP [ 11 , 21 , 22 ]. Although debate continues regarding the differences and similarities between influenza and COVID-associated aspergillosis [ 10 ], in keeping with our findings in bacterial VAP it appears that IPA is more common in COVID-19 patients than in ICU patients without COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…We also looked for evidence of invasive pulmonary aspergillosis (IPA), as there are now several case reports of this developing in patients with COVID-19 [ 11 ] and recent reports of its frequency in non-COVID VAP [ 21 ]. IPA was defined using the criteria set out in the report describing influenza associated pulmonary aspergillosis [ 22 ] modified to include diagnosis by PCR.…”

Section: Methodsmentioning

confidence: 99%

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Ventilator-associated pneumonia in critically ill patients with COVID-19

et al. 2021

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Background Pandemic COVID-19 caused by the coronavirus SARS-CoV-2 has a high incidence of patients with severe acute respiratory syndrome (SARS). Many of these patients require admission to an intensive care unit (ICU) for invasive ventilation and are at significant risk of developing a secondary, ventilator-associated pneumonia (VAP). Objectives To study the incidence of VAP and bacterial lung microbiome composition of ventilated COVID-19 and non-COVID-19 patients. Methods In this retrospective observational study, we compared the incidence of VAP and secondary infections using a combination of microbial culture and a TaqMan multi-pathogen array. In addition, we determined the lung microbiome composition using 16S RNA analysis in a subset of samples. The study involved 81 COVID-19 and 144 non-COVID-19 patients receiving invasive ventilation in a single University teaching hospital between March 15th 2020 and August 30th 2020. Results COVID-19 patients were significantly more likely to develop VAP than patients without COVID (Cox proportional hazard ratio 2.01 95% CI 1.14–3.54, p = 0.0015) with an incidence density of 28/1000 ventilator days versus 13/1000 for patients without COVID (p = 0.009). Although the distribution of organisms causing VAP was similar between the two groups, and the pulmonary microbiome was similar, we identified 3 cases of invasive aspergillosis amongst the patients with COVID-19 but none in the non-COVID-19 cohort. Herpesvirade activation was also numerically more frequent amongst patients with COVID-19. Conclusion COVID-19 is associated with an increased risk of VAP, which is not fully explained by the prolonged duration of ventilation. The pulmonary dysbiosis caused by COVID-19, and the causative organisms of secondary pneumonia observed are similar to that seen in critically ill patients ventilated for other reasons.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ventilator-associated pneumonia in critically ill patients with COVID-19

et al. 2021

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“…In respiratory diseases, the penetration of the pathogen components (nucleic acids or proteins) into non-respiratory body uids is likely, but their detection is usually considered of minor value because of the focal nature of the pathogenesis and its strong association with mucous immunity. Despite that, certain respiratory infections can be e ciently diagnosed and monitored by detection of corresponding antigens in the blood; the examples include galactomannan in pulmonary aspergillosis [4] and L. pneumophila antigen in urine of Legionnaires' disease patients [5]. In addition, the use of serological immunoassays for the management of virusassociated nosocomial pneumonias in intensive care unit patients has been reported [4,6].…”

Section: Introductionmentioning

confidence: 99%

“…Despite that, certain respiratory infections can be e ciently diagnosed and monitored by detection of corresponding antigens in the blood; the examples include galactomannan in pulmonary aspergillosis [4] and L. pneumophila antigen in urine of Legionnaires' disease patients [5]. In addition, the use of serological immunoassays for the management of virusassociated nosocomial pneumonias in intensive care unit patients has been reported [4,6]. Serum nucleocapsid antigen (N-Ag) of SARS virus was described in SARS-associated pneumonia by Che et al [7] In this article, we report evaluation of the SARS-CoV-2 nucleocapsid antigen (N-Ag) and respective antibodies as diagnostic markers and demonstrate the total prevalence of N-Ag seroconversion in SARS-CoV-2-associated pneumonia patients.…”

Section: Introductionmentioning

confidence: 99%

The Importance of SARS-CoV-2 N-Ag Serodiagnostics for the Management of COVID-19 Pneumonia in Hospital Settings

Lebedin¹,

Lyang

Galstyan³

et al. 2020

Preprint

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We report evaluation of the SARS-CoV-2 nucleocapsid antigen (N-Ag) and respective antibodies as diagnostic markers in pneumonia patients. The study was conducted at the height of COVID-19 pandemic in Moscow, Russia. It included 425 emergency patients with clinical signs of COVID-19 pneumonia, of which 280 (66%) were positive for either serum N-Ag and/or its respective antibodies. We demonstrate the total prevalence of N-Ag seroconversion in SARS-CoV-2-associated pneumonia patients within 3-5 days after hospital admission. The results indicate high feasibility of SARS-CoV-2 serodiagnostics in emergency patients.

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“…In this issue of the Journal , Loughlin and colleagues (pp. 1125–1132 ) ( 8 ) present the retrospective results of a multicenter UK study of two cohorts of patients with suspected VAP. The same methodology was applied in 194 nonimmunosuppressed patients, which included BAL with stains and semiquantitative standard cultures for bacteria and fungi.…”

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confidence: 99%

Invasive Pulmonary Aspergillosis in Ventilator-associated Pneumonia: The Hidden Enemy?

Torres

Martín‐Loeches

2020

Am J Respir Crit Care Med

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room air between interventions, resulting in low probability of contamination between sequential experimental conditions. Sufficient time to ensure that the particle concentrations return to baseline is necessary between interventions in future studies, especially if frequent air exchange is not available. Optimal respiratory management of patients suffering from COVID-19 pneumonia is debated; the potential benefits of early intubation, NIV, and HFNC, to be put into balance with the potential risk of bioaerosol generation and dispersion, are controversial; and practice is heterogeneous between units and over time during the pandemic spread (13, 14). As evidence is accumulating against a significantly increased bioaerosol generation associated with the use of HFNC and NIV, clinicians may consider those therapeutic options as they do when caring for patients with hypoxemia without COVID-19, not overemphasizing the potential theoretical risk of increased infectious transmission. In any case, personal protective equipment should be worn by professionals caring for patients with suspected or confirmed COVID-19. Beyond bioaerosol generation and dispersion, the crucial question that needs to be answered remains the infectious potential of the virus carried by the bioaerosols generated by the patients or various procedures and its relative quantitative importance compared with other routes of viral dissemination such as surface contact. n Author disclosures are available with the text of this article at www.atsjournals.org.

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Pulmonary Aspergillosis in Patients with Suspected Ventilator-associated Pneumonia in UK ICUs

Cited by 43 publications

References 29 publications

Ventilator-associated pneumonia in critically ill patients with COVID-19

Ventilator-associated pneumonia in critically ill patients with COVID-19

The Importance of SARS-CoV-2 N-Ag Serodiagnostics for the Management of COVID-19 Pneumonia in Hospital Settings

Invasive Pulmonary Aspergillosis in Ventilator-associated Pneumonia: The Hidden Enemy?

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