Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study.

Autor: Lahmer T; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Kriescher S; Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Herner A; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Rothe K; Institut für Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany., Spinner CD; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Schneider J; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Mayer U; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Neuenhahn M; Institut für Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany., Hoffmann D; Institut für Virologie, Technische Universität München, Munich, Germany., Geisler F; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Heim M; Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Schneider G; Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Schmid RM; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Huber W; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany., Rasch S; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Mar 17; Vol. 16 (3), pp. e0238825. Date of Electronic Publication: 2021 Mar 17 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0238825
Abstrakt: Background: Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia.
Methods: We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls.
Findings: CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA.
Interpretation: CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.
Competing Interests: Tobias T.L. received travel grants from Gilead, Pfizer and MSD. CDS received travel grants/honoraria from AbbVie, Gilead, Janssen, MSD and ViiV Healthcare. CDS received funding for clinical research from Gilead, Janssen and ViiV Healthcare. The received grants/funding were not related to the submitted manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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