ABSTRACT
Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.
ABSTRACT
Introduction: Coronavirus disease associated pulmonary aspergillosis (CAPA), can be a devastating complication in patients on mechanical ventilation (MV) and ARDS. Recently, we had implemented an active screening and surveillance protocol, focused on the early detection of CAPA. Here we present our institutional results. Methods: We included all consecutive patients admitted to a polyvalent ICU, with SARS-CoV-2 pneumonia, from Mar 2020 to Jul 2021. The protocol was implemented in Aug 2020. Our surveillance protocol consists of lower respiratory track samples, obtaining by bronchial aspiration, processed with calcofluor staining, once a week. In case of positive results, respiratory or clinical worsening, we collect lower respiratory track samples by bronchoalveolar lavage (BAL). Probable CAPA definition is in accordance with ECMM/ISHAM consensus criteria [1]. Results: During the study period, 345 patients were admitted in our ICU with SARS-CoV-2 pneumonia related ARDS. 90% required invasive MV. The mean age was 60 years, 69% were male, with severity scores mean values of SOFA 6.4, APACHE II 16.5, and SAPS II 39.5. 8.7% (n = 30) of the patients met the diagnostic criteria of probable CAPA. 90% with GM index > 1 in BAL. 70% with culture samples and GM assay from BAL were positive. This represents a global incidence of 8.7%. The ICU mortality in patients with probable CAPA was 23.3%. The ICU mortality of patients on MV without CAPA was 15.7% (p = 0.3). Conclusions: CAPA is a severe complication and entails significant increase in morbi-mortality. We implemented an active surveillance system in our ICU. Early and timely detection, together with optimal organ support management could have influenced clinical outcomes, lowering the ICU mortality rate. In our sample, this mortality is not statistically significant despite being higher than in the non-CAPA group. It is possible that this difference was not greater, thanks to the proposed active surveillance protocol. (Table Presented).