Clinical characteristics, bacterial coinfections and outcomes in COVID-19-associated pulmonary aspergillosis in a third-level Mexican hospital during the COVID-19 pre-vaccination era.

Autor: Hernández-Silva G; Infectious Diseases Department, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Corzo-León DE; MRC Medical Mycology Centre at University of Exeter, Exeter, UK., Becerril-Vargas E; Microbiology Clinical Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Peralta-Prado AB; Research Centre of Infectious Diseases, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Odalis RG; Pharmacology Department, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Morales-Villarreal F; Microbiology Clinical Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Ríos-Ayala MA; Intensive Care Unit, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Alonso TG; Pneumology Service, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Agustín FD; Pneumology Service, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Ramón AF; Pneumology Service, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico., Hugo AV; Infectious Diseases Department, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.
Jazyk: angličtina
Zdroj: Mycoses [Mycoses] 2024 Jan; Vol. 67 (1), pp. e13693.
DOI: 10.1111/myc.13693
Abstrakt: Background: Damage due to respiratory viruses increases the risk of bacterial and fungal coinfections and superinfections. High rates of invasive aspergillosis are seen in severe influenza and COVID-19. This report describes CAPA cases diagnosed during the first wave in the biggest reference centre for severe COVID-19 in Mexico.
Objectives: To describe the clinical, microbiological and radiological characteristics of patients with invasive pulmonary aspergillosis associated with critical COVID-19, as well as to describe the variables associated with mortality.
Methods: This retrospective study identified CAPA cases among individuals with COVID-19 and ARDS, hospitalised from 1 March 2020 to 31 March 2021. CAPA was defined according to ECMM/ISHAM consensus criteria. Prevalence was estimated. Clinical and microbiological characteristics including bacterial superinfections, antifungal susceptibility testing and outcomes were documented.
Results: Possible CAPA was diagnosed in 86 patients among 2080 individuals with severe COVID-19, representing 4.13% prevalence. All CAPA cases had a positive respiratory culture for Aspergillus species. Aspergillus fumigatus was the most frequent isolate (64%, n = 55/86). Seven isolates (9%, n = 7/80) were resistant to amphotericin B (A. fumigatus n = 5/55, 9%; A. niger, n = 2/7, 28%), two A. fumigatus isolates were resistant to itraconazole (3.6%, n = 2/55). Tracheal galactomannan values ranged between 1.2 and 4.05, while serum galactomannan was positive only in 11% (n = 3/26). Bacterial coinfection were documented in 46% (n = 40/86). Gram negatives were the most frequent cause (77%, n = 31/40 isolates), from which 13% (n = 4/31) were reported as multidrug-resistant bacteria. Mortality rate was 60% and worse prognosis was seen in older persons, high tracheal galactomannan index and high HbA1c level.
Conclusions: One in 10 individuals with CAPA carry a resistant Aspergillus isolate and/or will be affected by a MDR bacteria. High mortality rates are seen in this population.
(© 2024 The Authors. Mycoses published by Wiley-VCH GmbH.)
Databáze: MEDLINE
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