Incidence and Risk Factors of COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit—A Monocentric Retrospective Observational Study

Abstract

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is an increasingly recognized complication of COVID-19 and is associated with significant over-mortality. We performed a retrospective monocentric study in patients admitted to the intensive care unit (ICU) for respiratory insufficiency due to COVID-19 from March to December 2020, in order to evaluate the incidence of CAPA and the associated risk factors. We also analysed the diagnostic approach used in our medical centre for CAPA diagnosis. We defined CAPA using recently proposed consensus definitions based on clinical, radiological and microbiological criteria. Probable cases of CAPA occurred in 9 out of 141 patients included in the analysis (6.4%). All cases were diagnosed during the second wave of the pandemic. We observed a significantly higher realization rate of bronchoalveolar lavage (BAL) (51.1% vs. 28.6%, p = 0.01) and Aspergillus testing (through galactomannan, culture, PCR) on BAL samples during the second wave (p < 0.0001). The testing for Aspergillus in patients meeting the clinical and radiological criteria of CAPA increased between the two waves (p < 0.0001). In conclusion, we reported a low but likely underestimated incidence of CAPA in our population. A greater awareness and more systematic testing for Aspergillus were necessary to assess the real incidence and characteristics of CAPA.

COVID‐19‐associated pulmonary aspergillosis (CAPA): Risk factors and development of a predictive score for critically ill COVID‐19 patients

“…Although the prevalence of CAPA in our ICU‐admitted patients (6.04%) is similar to other works 27 and is consistent with studies in our setting 31 and autopsy studies, 32 some other authors have noted a higher prevalence, 4 , 12 , 28 , 33 up to 30%. 34 These differences could be related to regional variations in incidence.…”

“…Previous studies have identified risk factors for CAPA, including age, prior respiratory diseases, chronic renal failure, chronic corticosteroid use, neutropenia, COVID‐19 severity and treatment of the COVID‐19 episode with corticosteroid or tocilizumab 4,13,26‐28 . In the present study, we could validate most of these factors.…”

“…Previous studies have identified risk factors for CAPA, including age, prior respiratory diseases, chronic renal failure, chronic corticosteroid use, neutropenia, COVID‐19 severity and treatment of the COVID‐19 episode with corticosteroid or tocilizumab. 4 , 13 , 26 , 27 , 28 In the present study, we could validate most of these factors. However, we could not corroborate the association between corticosteroid treatment for COVID‐19 and CAPA, since, due to local protocols, corticosteroids were extensively used in COVID‐19 patients very early in the pandemic.…”

COVID-19-associated pulmonary aspergillosis (CAPA) in Iranian patients admitted with severe COVID-19 pneumonia

“…Systemic fungal superinfections can negatively impact the prognosis and subsequently increase the mortality rate among patients with COVID-19. Certain risk factors ascribed to the development of CAPA, include age, prior respiratory diseases, chronic renal failure, long-term use of corticosteroid, neutropenia, COVID-19 severity, and treatment of COVID-19 patient with corticosteroid or tocilizumab [ 12 , 13 , 23 , 24 ]. In the present study, 17 isolates were recovered from cases considered to be CAPA.…”

COVID-19-Associated Fungal Infections: An Urgent Need for Alternative Therapeutic Approach?

“…The overlapping respiratory manifestations complicate the treatment of COVID-19. Prolonged hospitalization period and potentially required mechanical ventilation along with lymphopenia, leukopenia, and systemic hyperinflammatory reaction facilitates the growth of fungi in COVID-19 patients ( Arastehfar et al, 2020a ; Amin et al, 2021 ; Baddley et al, 2021 ; Gregoire et al, 2021 ). In addition, World Health Organization (WHO) COVID-19 treatment guideline recommend empirically prescribed broad-spectrum antibiotics to treat possible bacterial co-infections, but only in severe COVID-19 patients ( World Health Organization, 2021 ).…”