Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort

Dellière, Sarah; Dudoignon, Emmanuel; Fodil, Sofiane; Voicu, Sébastian; Collet, Magalie; Oillic, Pierre-Antoine; Salmona, Maud; Dépret, François; Ghelfenstein-Ferreira, Théo; Plaud, Benoît; Chousterman, Benjamin; Bretagne, Stéphane; Azoulay, Élie; Mebazaa, Alexandre; Mégarbane, Bruno; Alanio, Alexandre

doi:10.1016/j.cmi.2020.12.005

Cited by 127 publications

(178 citation statements)

References 20 publications

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“…33,34 So far, only few studies have investigated fungal superinfections in COVID-19 patients. [13][14][15]17,[35][36][37] The significance of viral reactivation remains unclear. 11 In our study, reactivations of HSV-1 and HHV-6 in the serum occurred in patients with bacterial superinfections.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 However, COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in several cohorts of critically ill patients. 13,14 Still, there is a lack of knowledge about the frequency and significance of bacterial, fungal, and viral concomitant infections in critically ill COVID-19 patients. 12 Additionally, in most studies performed so far, no thorough and systematic sampling for concomitant infections was performed.…”

Section: Introductionmentioning

confidence: 99%

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Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients

Buehler

Zinkernagel

Hofmaenner

et al. 2021

Cell Reports Medicine

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The impact of secondary bacterial infections (superinfections) in COVID-19 is not well understood. In this prospective, monocentric cohort study we aim to investigate the impact of superinfections in COVID-19 patients with acute respiratory distress syndrome. Patients are assessed for concomitant microbial infections by longitudinal analysis of tracheobronchial secretions, bronchoalveolar lavages and blood cultures. In 45 critically ill patients, we identify 19 patients with superinfections (42.2%). Superinfections are detected on day 10 after intensive care admission. The proportion of participants alive and off invasive mechanical ventilation at study day 28 (ventilator-free days (VFDs) at 28 days) is substantially lower in patients with superinfection (subhazard ratio 0.37, 95%-CI 0.15-0.90, p=0.028). Patients with pulmonary superinfections have a higher incidence of bacteraemia, virus reactivations, yeast colonization, and required intensive care treatment for a longer time. Superinfections are frequent and associated with reduced VFDs at 28 days despite a high rate of empirical antibiotic therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients

Buehler

Zinkernagel

Hofmaenner

et al. 2021

Cell Reports Medicine

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“…Because SARS-CoV-2 and treatments such as dexamethasone or tocilizumab can impair the immune system, some researchers anticipated the possibility of fungal superinfection among COVID-19 patients ( 3 – 6 ). As of August 2020, researchers have documented COVID-19–associated pulmonary aspergillosis (CAPA) ( 7 – 9 ), invasive candidiasis ( 10 ), coccidioidomycosis ( 11 ), fusariosis ( 12 ), histoplasmosis ( 13 ), mucormycosis ( 14 ), pneumocystosis ( 15 ), and saccharomycosis ( 16 ). Varying cumulative rates of CAPA have been described, including rates of 0.7%–7.7% among COVID-19 patients ( 17 , 18 ), 2.5%–39.1% among ICU patients with COVID-19 ( 19 , 20 ), and 3.2%–29.6% among COVID-19 patients on mechanical ventilation ( 7 , 17 ).…”

mentioning

confidence: 99%

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020

Salmanton‐García¹,

Sprute²,

Stemler³

et al. 2021

Emerg. Infect. Dis.

205

219

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Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease–associated pulmonary aspergillosis (CAPA) worldwide during March–August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

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“…Much of the latter includes opportunistic Gram-negative bacilli [49,100,118,119,123,124,126,137,138,140,144,145,147,148]. Fungal infections, especially with Candida spp., occur with worse disease and increased hospital stay [118,126,135,136,139,144,145,147,[149][150][151]. The latter may occur in up to 14% of such patients [134,138,139].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Infectionsmentioning

confidence: 99%

“…The latter may occur in up to 14% of such patients [134,138,139]. As anticipated, antimicrobial therapy and steroid use can pose as risk factors for such invasive fungal infections [147,151].…”

Section: The Impact Of Covid-19 On Associated Post-onset Bacterial Infectionsmentioning

confidence: 99%

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

Cimolai

2021

SN Compr. Clin. Med.

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Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort

Cited by 127 publications

References 20 publications

Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients

Bacterial pulmonary superinfections are associated with longer duration of ventilation in critically ill COVID-19 patients

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020

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

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