High Burden of COVID-19-Associated Pulmonary Aspergillosis in Severely Immunocompromised Patients Requiring Mechanical Ventilation
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a frequent superinfection in critically ill patients with COVID-19 and is associated with increased mortality rates. The increasing proportion of severely immunocompromised patients with COVID-19 who require mechanical...
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| Published in: | Clinical infectious diseases Vol. 78; no. 2; pp. 361 - 370 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
United States
Oxford University Press
17-02-2024
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a frequent superinfection in critically ill patients with COVID-19 and is associated with increased mortality rates. The increasing proportion of severely immunocompromised patients with COVID-19 who require mechanical ventilation warrants research into the incidence and impact of CAPA during the vaccination era.
We performed a retrospective, monocentric, observational study. We collected data from adult patients with severe COVID-19 requiring mechanical ventilation who were admitted to the intensive care unit (ICU) of University Hospitals Leuven, a tertiary referral center, between 1 March 2020 and 14 November 2022. Probable or proven CAPA was diagnosed according to the 2020 European Confederation for Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) criteria.
We included 335 patients. Bronchoalveolar lavage sampling was performed in 300 (90%), and CAPA was diagnosed in 112 (33%). The incidence of CAPA was 62% (50 of 81 patients) in European Organisation for Research and Treatment of Cancer (EORTC)/Mycosis Study Group Education and Research Consortium (MSGERC) host factor-positive patients, compared with 24% (62 of 254) in host factor-negative patients. The incidence of CAPA was significantly higher in the vaccination era, increasing from 24% (57 of 241) in patients admitted to the ICU before October 2021 to 59% (55 of 94) in those admitted since then. Both EORTC/MSGERC host factors and ICU admission in the vaccination era were independently associated with CAPA development. CAPA remained an independent risk factor associated with mortality risk during the vaccination era.
The presence of EORTC/MSGERC host factors for invasive mold disease is associated with increased CAPA incidence and worse outcome parameters, and it is the main driver for the significantly higher incidence of CAPA in the vaccination era. Our findings warrant investigation of antifungal prophylaxis in critically ill patients with COVID-19. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Potential conflicts of interest. S. F. and L. V. report PhD funding from the Research Foundation–Flanders (FWO; grants 11M6922N and 11E9819N). S. F. reports receipt of travel grants from Pfizer and Gilead and speaker fees from Healthbook. K. L. received consultancy fees from MRM Health, Merck Sharp and Dohme (MSD), and Mundipharma, speaker fees and travel support from Pfizer and Gilead, and a service fee from Thermo Fisher Scientific and TECOmedical and participated on an advisory board for MSD. Y. D. received travel grants from Pfizer (travel/congress attendance support) and declares participation on advisory boards for Pfizer and MSD. G. H. and R. V. are senior clinical research fellows of FWO. G. H. received travel fees from Eurosets for the 2023 Extracorporeal Life Support Organization meeting. M. H. received grants from Astellas, Gilead, MSD, Pfizer, Euroimmun, IMMY, Mundipharma, F2G, Pulmocide, and Scynexis and research funding from Gilead Sciences, Astellas, Mundipharma, Euroimmun, MSD, Pulmocide, IMMY, Scynexis, F2G, and Pfizer. J. M. received grants from Bio-Rad, Gilead Sciences, MSD, F2G, Mundipharma, and Pfizer; personal fees and nonfinancial support from Astellas, Basilea, Gilead Sciences, MSD, F2G, Mundipharma, and Pfizer; and personal fees from Bio-Rad. M. P. received travel fees from Pfizer (March 2023; registration for the 2023 International Symposium on Intensive Care & Emergency Medicine (ISICEM) in Brussels, Belgium). I. S. received funding from the Clinical Research Fund, University Hospitals Leuven, investigator-initiated grants from Pfizer, and speaker and travel fees from Pfizer, Gilead, and MSD, and reports participation on an advisory board for Pfizer and Gilead, and receipt of study drugs from MSD. L. V. received support for public doctoral defense from Pfizer and travel fees for conference attendance from Gilead Sciences and Pfizer and reports a PhD fellowship (grant 11E9819N) from FWO. R. V. reports an FWO fellowship and grant (grant G060322N). E. V. W. received travel fees from Gilead (for travel, hotel, and registration). J. W. received investigator-initiated grants from Pfizer, Gilead, and MSD and speaker and travel fees from Pfizer, Gilead, and MSD, and declares participation on advisory boards of Pfizer and Gilead and receipt of study drugs from MSD. J. W. also reports funding from the European Union's Horizon 2020 research and innovation program (grant 847507 HDM-FUN) and FWO project funding (grant G053121N). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. |
| ISSN: | 1058-4838 1537-6591 |
| DOI: | 10.1093/cid/ciad546 |