Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study

Gangneux, Jean‐Pierre; Dannaoui, Éric; Fekkar, Arnaud; Luyt, Charles‐Édouard; Botterel, Françoise; Prost, Nicolas de; Tadié, Jean‐Marc; Reizine, Florian; Houzé, Sandrine; Timsit, Jean‐François; Iriart, Xavier; Riu-Poulenc, Béatrice; Sendid, Boualem; Nseir, Saad; Persat, Florence; Wallet, Florent; Pape, Patrice Le; Canet, Emmanuel; Novara, Ana; Manai, Melek; Cateau, Estelle; Thille, Arnaud W.; Brun, Sophie; Cohen, Yves; Alanio, Alexandre; Mégarbane, Bruno; Cornet, Muriel; Terzi, Nicolas; Lamhaut, Lionel; Sabourin, Estelle; Désoubeaux, Guillaume; Ehrmann, Stéphan; Hennequin, Christophe; Voiriot, Guillaume; Nevez, Gilles; Aubron, Cécile; Letscher-Bru, Valérie; Meziani, Ferhat; Blaize, Marion; Mayaux, Julien; Monsel, Antoine; Boquel, Frédérique; Robert‐Gangneux, Florence; Tulzo, Yves Le; Séguin, Philippe; Guegan, Hélène; Autier, Brice; Lesouhaitier, M.; Pelletier, Romain; Belaz, Sorya; Bonnal, Christine; Berry, Antoine; Leroy, Jordan; François, Nadine; Richard, Jean‐Christophe; Paulus, S.; Argaud, Laurent; Dupont, Damien; Menotti, Jean; Morio, Florent; Soulié, Marie; Schwebel, Carole; Garnaud, Cécile; Guitard, Juliette; Gal, Solène Le; Quinio, Dorothée; Morçet, Jeff; Laviolle, Bruno; Zahar, Jean‐Ralph; Bougnoux, Marie‐Elisabeth

doi:10.1016/s2213-2600(21)00442-2

Cited by 211 publications

(311 citation statements)

References 33 publications

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“…To gather this literature, we used the search string "((COVID) OR (SARS-CoV2) OR (SARS-CoV-2)) AND (Aspergill*)" in Pubmed, with which 273 results were obtained until 12 October 2021. One additional paper in preprint was added through a reference search in these articles, and this paper was published during the writing process of this review [9].…”

Section: Methodsmentioning

confidence: 99%

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Feys

Almyroudi

Braspenning

et al. 2021

JoF

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Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe fungal infection complicating critically ill COVID-19 patients. Numerous retrospective and prospective studies have been performed to get a better grasp on this lethal co-infection. We performed a qualitative review and summarized data from 48 studies in which 7047 patients had been included, of whom 820 had CAPA. The pooled incidence of proven, probable or putative CAPA was 15.1% among 2953 ICU-admitted COVID-19 patients included in 18 prospective studies. Incidences showed great variability due to multiple factors such as discrepancies in the rate and depth of the fungal work-up. The pathophysiology and risk factors for CAPA are ill-defined, but therapy with corticosteroids and anti-interleukin-6 therapy potentially confer the biggest risk. Sampling for mycological work-up using bronchoscopy is the cornerstone for diagnosis, as imaging is often aspecific. CAPA is associated with an increased mortality, but we do not have conclusive data whether therapy contributes to an increased survival in these patients. We conclude our review with a comparison between influenza-associated pulmonary aspergillosis (IAPA) and CAPA.

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Section: Methodsmentioning

confidence: 99%

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Feys

Almyroudi

Braspenning

et al. 2021

JoF

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“…can be isolated from culture of tracheal aspirates in intubated patients, fiberoptic bronchoscopy is required to identify invasive pulmonary aspergillosis following galactomannan test and RT-PCR on bronchoalveolar lavage, while serum Beta-D-glucan antigens may help to rule out fungal infection in immunocompromised patients [ 65 ]. However, invasive pulmonary aspergillosis is increasingly diagnosed in critically ill non-immunocompromised patients, especially in those with viral pneumonia such as severe influenza [ 66 , 67 , 68 ] or COVID-19 [ 69 , 70 , 71 ], and bronchoalveolar lavage may be advisable to rule out invasive pulmonary aspergillosis in this setting. Bronchoalveolar lavage remains an essential diagnostic tool not only for diagnosis of pulmonary fungal infection in immunocompromised patients under invasive mechanical ventilation, but also for diagnosis of invasive pulmonary aspergillosis in patients with viral ARDS due to severe influenza or COVID-19.…”

Section: Proposed Diagnostic Approach For Identification Of Ards Etiologymentioning

confidence: 99%

Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

2021

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Acute respiratory distress syndrome (ARDS) is a life-threatening condition defined by the acute onset of severe hypoxemia with bilateral pulmonary infiltrates, in the absence of a predominant cardiac involvement. Whereas the current Berlin definition was proposed in 2012 and mainly focused on intubated patients under invasive mechanical ventilation, the recent COVID-19 pandemic has highlighted the need for a more comprehensive definition of ARDS including patients treated with noninvasive oxygenation strategies, especially high-flow nasal oxygen therapy, and fulfilling all other diagnostic criteria. Early identification of ARDS in patients breathing spontaneously may allow assessment of earlier initiation of pharmacological and non-pharmacological treatments. In the same way, accurate identification of the ARDS etiology is obviously of paramount importance for early initiation of adequate treatment. The precise underlying etiological diagnostic (bacterial, viral, fungal, immune, malignant, drug-induced, etc.) as well as the diagnostic approach have been understudied in the literature. To date, no clinical practice guidelines have recommended structured diagnostic work-up in ARDS patients. In addition to lung-protective ventilation with the aim of preventing worsening lung injury, specific treatment of the underlying cause has a central role to improve outcomes. In this review, we discuss early identification of ARDS in non-intubated patients breathing spontaneously and propose a structured diagnosis work-up.

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“…Nonetheless, these estimations for excess mortality caused by the two most common fungal co-/secondary infections encountered with severe COVID-19 align with prior smaller reports from individual centres (nationwide and worldwide) and the recent French study on CAPA in that mortality and LoS are increased in patients with COVID-19 and fungal co-/secondary infection. 4 , 7 , 10 , 12 This data analysis further emphasises the importance of raised awareness, testing, rapid diagnosis, surveillance and prompt and appropriate treatment of fungal infections in severely ill patients with COVID-19.…”

mentioning

confidence: 93%

“… 4 , 7 , 8 , 10 A recent French multi-centre study confirmed significant increased mortality in patients with possible or probable CAPA. 12 Here we report data to quantify the impact of fungal co- and secondary infections on outcomes of patients admitted to intensive care units (ICU) in NHS hospitals in England with laboratory confirmed COVID-19 and likely or proven fungal disease, concentrating on CAPA and COVID-associated candidaemia (CAC), since few UK cases of CAM have been reported as of November 2021.…”

mentioning

confidence: 99%

Increased mortality in COVID-19 patients with fungal co- and secondary infections admitted to intensive care or high dependency units in NHS hospitals in England

Borman

Fountain²,

Guy³

et al. 2022

Journal of Infection

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Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study

Cited by 211 publications

References 33 publications

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Early Identification and Diagnostic Approach in Acute Respiratory Distress Syndrome (ARDS)

Increased mortality in COVID-19 patients with fungal co- and secondary infections admitted to intensive care or high dependency units in NHS hospitals in England

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