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Mortality in critically ill COVID­19 patients with fungal infections: a comprehensive systematic review and meta­analysis.
Krzych, Lukasz J; Putowski, Zbigniew; Gruca, Karol; Pluta, Michal P.
  • Krzych LJ; Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
  • Putowski Z; Student Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
  • Gruca K; Student Scientific Society, Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland. gruca.karol61@gmail.com
  • Pluta MP; Department of Anesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
Pol Arch Intern Med ; 132(5)2022 05 30.
Article in English | MEDLINE | ID: covidwho-1727115
ABSTRACT

INTRODUCTION:

Patients with COVID­19 may develop concomitant viral, bacterial, or fungal infections. Such patients are at a higher risk of death, especially from a critical illness. Although much attention has been recently given to fungal infections that may have devastating consequences, data on this issue are scarce.

OBJECTIVES:

The aim of the study was to assess the impact and prevalence of fungal infections in critically ill patients with COVID 19.

METHODS:

We systematically searched for studies that focused on critically ill adults diagnosed with COVID­19 and a fungal coinfection. Mortality was our outcome of interest. The search was conducted within MEDLINE, Web of Science, clinicaltrials.gov, Embase, and Cochrane Library on January 8, 2022.

RESULTS:

We reviewed 38 papers covering 17 695 patients, 1182 (6.7%) of whom had an acquired fungal infection. The overall mortality in the papers retrieved for a systematic review (n = 38) varied from 29% to 100% (median [IQR], 56% [40%-77%]). In a meta­analysis (19 studies), the patients with a fungal infection were more likely to die than the controls (odds ratio [OR], 2.987; 95% CI, 2.369-3.767; P <0.001; I2 = 26.63%). Subgroup analyses showed that COVID­19-associated pulmonary aspergillosis (CAPA) increased mortality by 3 times (OR, 3.279; 95% CI, 2.692-3.994; P <0.001; I2 = 0%), and that COVID­19-associated candidiasis (CAC) increased mortality by 2 times (OR, 2.254; 95% CI, 1.322-3.843; I2 = 26.14%).

CONCLUSIONS:

In critically ill patients with COVID­ 19, CAPA is rather common and significantly increases mortality. The evidence regarding other fungal infections is weaker, with CAC occurring less frequently but also impacting mortality. Therefore, clinical awareness and screening are needed, followed by personalized antifungal therapy stewardship, which is strongly recommended in order to improve the patients' prognosis.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Mycoses Type of study: Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Humans Language: English Year: 2022 Document Type: Article Affiliation country: Pamw.16221

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Mycoses Type of study: Observational study / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Humans Language: English Year: 2022 Document Type: Article Affiliation country: Pamw.16221