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Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients-a multinational observational study by the European Confederation of Medical Mycology.
Prattes, Juergen; Wauters, Joost; Giacobbe, Daniele Roberto; Salmanton-García, Jon; Maertens, Johan; Bourgeois, Marc; Reynders, Marijke; Rutsaert, Lynn; Van Regenmortel, Niels; Lormans, Piet; Feys, Simon; Reisinger, Alexander Christian; Cornely, Oliver A; Lahmer, Tobias; Valerio, Maricela; Delhaes, Laurence; Jabeen, Kauser; Steinmann, Joerg; Chamula, Mathilde; Bassetti, Matteo; Hatzl, Stefan; Rautemaa-Richardson, Riina; Koehler, Philipp; Lagrou, Katrien; Hoenigl, Martin.
  • Prattes J; Medical University of Graz, Department of Infectious Diseases, Excellence Centre for Medical Mycology (ECMM), Graz, Austria.
  • Wauters J; Universitair Ziekenhuis Leuven, Leuven, Belgium. Electronic address: joost.wauters@kuleuven.be.
  • Giacobbe DR; San Martino Polyclinic Hospital IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
  • Salmanton-García J; University of Cologne, Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Ge
  • Maertens J; Universitair Ziekenhuis Leuven, Leuven, Belgium.
  • Bourgeois M; Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Bruges, Belgium.
  • Reynders M; Algemeen Ziekenhuis Sint-Jan Brugge-Oostende, Bruges, Belgium.
  • Rutsaert L; Ziekenhusnetwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
  • Van Regenmortel N; Ziekenhusnetwerk Antwerp, Campus Stuivenberg, Antwerp, Belgium.
  • Lormans P; Algemeen Ziekenhuis Delta, Roeselare, Belgium.
  • Feys S; Algemeen Ziekenhuis Delta, Roeselare, Belgium.
  • Reisinger AC; Medical University of Graz, Department of Internal Medicine, Intesive Care Unit, Graz, Austria.
  • Cornely OA; University of Cologne, Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Cologne, Germany; University of Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Ge
  • Lahmer T; Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
  • Valerio M; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
  • Delhaes L; Centre Hospitalier Universitaire de Bordeaux, ISERM U1045, Bordeaux, France.
  • Jabeen K; Aga Khan University, Karachi, Pakistan.
  • Steinmann J; Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany.
  • Chamula M; Manchester University NHS Foundation Trust, Wythenshawe Hospital and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK.
  • Bassetti M; San Martino Polyclinic Hospital IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
  • Hatzl S; Medical University of Graz, Department of Internal Medicine, Intesive Care Unit, Graz, Austria.
  • Rautemaa-Richardson R; Manchester University NHS Foundation Trust, Wythenshawe Hospital and Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, UK.
  • Koehler P; University of Cologne, Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Cologne, Germany.
  • Lagrou K; Universitair Ziekenhuis Leuven, Leuven, Belgium.
  • Hoenigl M; Medical University of Graz, Department of Infectious Diseases, Excellence Centre for Medical Mycology (ECMM), Graz, Austria; Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Clinical and Translational Fungal-Working Group, University o
Clin Microbiol Infect ; 28(4): 580-587, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1375916
ABSTRACT

OBJECTIVES:

Coronavirus disease 2019 (COVID-19) -associated pulmonary aspergillosis (CAPA) has emerged as a complication in critically ill COVID-19 patients. The objectives of this multinational study were to determine the prevalence of CAPA in patients with COVID-19 in intensive care units (ICU) and to investigate risk factors for CAPA as well as outcome.

METHODS:

The European Confederation of Medical Mycology (ECMM) conducted a multinational study including 20 centres from nine countries to assess epidemiology, risk factors and outcome of CAPA. CAPA was defined according to the 2020 ECMM/ISHAM consensus definitions.

RESULTS:

A total of 592 patients were included in this study, including 11 (1.9%) patients with histologically proven CAPA, 80 (13.5%) with probable CAPA, 18 (3%) with possible CAPA and 483 (81.6%) without CAPA. CAPA was diagnosed a median of 8 days (range 0-31 days) after ICU admission predominantly in older patients (adjusted hazard ratio (aHR) 1.04 per year; 95% CI 1.02-1.06) with any form of invasive respiratory support (HR 3.4; 95% CI 1.84-6.25) and receiving tocilizumab (HR 2.45; 95% CI 1.41-4.25). Median prevalence of CAPA per centre was 10.7% (range 1.7%-26.8%). CAPA was associated with significantly lower 90-day ICU survival rate (29% in patients with CAPA versus 57% in patients without CAPA; Mantel-Byar p < 0.001) and remained an independent negative prognostic variable after adjusting for other predictors of survival (HR 2.14; 95% CI 1.59-2.87, p ≤ 0.001).

CONCLUSION:

Prevalence of CAPA varied between centres. CAPA was significantly more prevalent among older patients, patients receiving invasive ventilation and patients receiving tocilizumab, and was an independent strong predictor of ICU mortality.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Aspergillosis / Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Humans Language: English Journal: Clin Microbiol Infect Journal subject: Communicable Diseases / Microbiology Year: 2022 Document Type: Article Affiliation country: J.cmi.2021.08.014

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Aspergillosis / Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Humans Language: English Journal: Clin Microbiol Infect Journal subject: Communicable Diseases / Microbiology Year: 2022 Document Type: Article Affiliation country: J.cmi.2021.08.014