Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study

Autor: Bartoletti, Michele, Pascale, Renato, Cricca, Monica, Rinaldi, Matteo, Maccaro, Angelo, Bussini, Linda, Fornaro, Giacomo, Tonetti, Tommaso, Pizzilli, Giacinto, Francalanci, Eugenia, Giuntoli, Lorenzo, Rubin, Arianna, Moroni, Alessandra, Ambretti, Simone, Trapani, Filippo, Vatamanu, Oana, Ranieri, Vito Marco, Castelli, Andrea, Baiocchi, Massimo, Lewis, Russell, Giannella, Maddalena, Viale, Pierluigi, Raumer, Luigi, Guerra, Luca, Tumietto, Fabio, Cascavilla, Alessandra, Zamparini, Eleonora, Verucchi, Gabriella, Coladonato, Simona, Ianniruberto, Stefano, Attard, Luciano, Volpato, Marina Tadolini Francesca, Virgili, Giulio, Rossi, Nicolò, Del Turco, Elena Rosselli, Guardigni, Viola, Fasulo, Giovanni, Dentale, Nicola, Fulgaro, Ciro, Legnani, Giorgio, Campaci, Emanuele, Basso, Cristina, Zuppiroli, Alberto, Passino, Amalia Sanna, Tesini, Giulia, Angelelli, Lucia, Badeanu, Adriana, Rossi, Agostino, Santangelo, Giulia, Dauti, Flovia, Koprivika, Vidak, Roncagli, Nicholas, Tzimas, Ioannis, Liuzzi, Guido Maria, Baxhaku, Irid, Pasinelli, Letizia, Neri, Mattia, Zanaboni, Tommaso, Dell’Omo, Francesco, Gori, Alice, Zavatta, Idina, Antonini, Stefano, Pironi, Chiara, Piccini, Elena, Esposito, Luca, Zuccotti, Alessandro, Urbinati, Giacomo, Pratelli, Agnese, Sarti, Alberto, Semprini, Michela, Evangelisti, Enrico, D’Onofrio, Mara, Sasdelli, Giuseppe
Přispěvatelé: Bartoletti, Michele, Pascale, Renato, Cricca, Monica, Rinaldi, Matteo, Maccaro, Angelo, Bussini, Linda, Fornaro, Giacomo, Tonetti, Tommaso, Pizzilli, Giacinto, Francalanci, Eugenia, Giuntoli, Lorenzo, Rubin, Arianna, Moroni, Alessandra, Ambretti, Simone, Trapani, Filippo, Vatamanu, Oana, Ranieri, Vito Marco, Castelli, Andrea, Baiocchi, Massimo, Lewis, Russell, Giannella, Maddalena, Viale, Pierluigi
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Clinical Infectious Diseases
ISSN: 1537-6591
1058-4838
DOI: 10.1093/cid/ciaa1065
Popis: Background We evaluated the incidence of invasive pulmonary aspergillosis among intubated patients with critical COVID-19 and evaluated different case definitions of invasive aspergillosis. Methods Prospective, multicenter study in adult patients with microbiologically confirmed COVID-19 receiving mechanical ventilation. All included participants underwent a screening protocol for invasive pulmonary aspergillosis with bronchoalveolar lavage galactomannan and cultures performed on admission at 7 days and in case of clinical deterioration. Cases were classified as coronavirus-associated pulmonary aspergillosis (CAPA) according to previous consensus definitions. The new definition was compared with putative invasive pulmonary aspergillosis (PIPA). Results 108 patients were enrolled. Probable CAPA was diagnosed in 30 (27.7%) patients after a median of 4 (2–8) days from intensive care unit (ICU) admission. Kaplan-Meier curves showed a significantly higher 30-day mortality rate from ICU admission among patients with either CAPA (44% vs 19%, P = .002) or PIPA (74% vs 26%, P < .001) when compared with patients not fulfilling criteria for aspergillosis. The association between CAPA (OR, 3.53; 95% CI, 1.29–9.67; P = .014) or PIPA (OR, 11.60; 95% CI, 3.24–41.29; P < .001) with 30-day mortality from ICU admission was confirmed, even after adjustment for confounders with a logistic regression model. Among patients with CAPA receiving voriconazole treatment (13 patients; 43%) a trend toward lower mortality (46% vs 59%; P = .30) and reduction in galactomannan index in consecutive samples were observed. Conclusions We found a high incidence of CAPA among critically ill COVID-19 patients and its occurrence seems to change the natural course of disease.
Databáze: OpenAIRE
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