Risk factors for COVID-19-associated pulmonary aspergillosis: a systematic review and meta-analysis

The Lancet Respiratory Medicine, Journal Year: 2024, Volume and Issue: 12(3), P. 207 - 216

Published: Jan. 4, 2024

Language: Английский

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Corticosteroids as risk factor for COVID-19-associated pulmonary aspergillosis in intensive care patients

Critical Care, Journal Year: 2022, Volume and Issue: 26(1)

Published: Jan. 28, 2022

Abstract Purpose Corticosteroids, in particular dexamethasone, are one of the primary treatment options for critically ill COVID-19 patients. However, there a growing number cases that involve COVID-19-associated pulmonary aspergillosis (CAPA), and it is unclear whether dexamethasone represents risk factor CAPA. Our aim was to investigate possible association recommended therapy with Methods We performed study based on cohort patients treated 2020 our 13 intensive care units at Charité Universitätsmedizin Berlin. used ECMM/ISHM criteria CAPA diagnosis univariate multivariable analyses clinical parameters identify factors could result Results Altogether, among n = 522 analyzed, 47 (9%) developed had higher simplified acute physiology score (SAPS) (64 vs. 53, p < 0.001) levels IL-6 (1,005 461, 0.008). They more often severe respiratory distress syndrome (ARDS) (60% 41%, 0.024), renal replacement they were likely die (64% 48%, 0.049). The analysis showed (OR 3.110, CI95 1.112–8.697) SAPS 1.063, 1.028–1.098) be independent Conclusion In study, as associated significant three times increase Trial registration Registration DRKS00024578, Date March 3rd, 2021.

Language: Английский

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Lower blood levels of isavuconazole in critically ill patients compared with other populations: possible need for therapeutic drug monitoring

Journal of Antimicrobial Chemotherapy, Journal Year: 2024, Volume and Issue: 79(4), P. 835 - 845

Published: Feb. 15, 2024

Isavuconazole is first-line treatment of invasive aspergillosis. Therapeutic drug monitoring (TDM) deemed not necessary, since most patients reached therapeutic levels (>1 mg/L) in large studies. Low were reported some critically ill admitted to the ICU. The aim was compare isavuconazole between and non-critically patients.

Language: Английский

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Invasive aspergillosis in critically ill patients with diabetes mellitus: a systematic review and meta-analysis

BMC Infectious Diseases, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 30, 2025

In the intensive care unit (ICU), invasive aspergillosis (IA) has a poor prognosis. Some studies report positive association between diabetes mellitus (DM) and IA in critically ill patients, but relationship DM ICU remains controversial. We aimed to clarify among patients systematic review meta-analysis. retrieved all reports published PubMed, EMBASE, Cochrane Library databases before July 12, 2023. calculated odds ratios (ORs) 95% confidence intervals (CIs) evaluate IA. Subgroup analyses were conducted further analyze sources of heterogeneity. Heterogeneity was evaluated using Cochran's Q test I2 statistic. Additionally, we publication bias funnel plots, Egger's test, Begg's test. Finally, sensitivity analysis robustness results. Twenty with 6155 participants included this found (OR = 1.18, CI:1.01 1.39; p 0.04). The heterogeneity not significant (I² 5%; 0.39) (Egger's test: 0.654; 0.417). results supported stable indicated that patients' comorbidities might be potential source had significantly higher risk COVID-19-associated pulmonary (CAPA) than those without 1.40, CI: 1.15 1.70; < 0.001). 0%; 0.91). subgroup influenza, OR 0.81 (95% 0.54, 1.23; 0.32; heterogeneity: 0.36; I² 8%). Patients showed developing DM. factor for IA, highest observed diagnosed CAPA.

Language: Английский

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COVID-19 associated mold infections: Review of COVID-19 associated pulmonary aspergillosis and mucormycosis

Journal of Microbiology Immunology and Infection, Journal Year: 2022, Volume and Issue: 56(3), P. 442 - 454

Published: Dec. 15, 2022

COVID-19-associated mold infection (CAMI) is defined as development of infections in COVID-19 patients. Co-pathogenesis viral and fungal include the disruption tissue barrier following SARS CoV-2 with damage alveolar space, respiratory epithelium endothelium injury overwhelming inflammation immune dysregulation during severe COVID-19. Other predisposing risk factors permissive to administration modulators such corticosteroids IL-6 antagonist. pulmonary aspergillosis (CAPA) mucormycosis (CAM) increasingly reported pandemic. CAPA usually developed within first month COVID infection, CAM frequently arose 10-15 days post diagnosis Diagnosis challenging often indistinguishable cytokine storm COVID-19, several diagnostic criteria have been proposed. Development associated a high mortality despiteappropriate anti-mold therapy. Both isavuconazole amphotericin B can be used for treatment CAM; voriconazole primary agent posaconazole an alternative CAM. Aggressive surgery recommended improve patient survival. A index suspicion timely appropriate crucial outcome.

Language: Английский

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Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit

BMC Infectious Diseases, Journal Year: 2024, Volume and Issue: 24(1)

Published: April 11, 2024

Abstract Background COVID-19-associated pulmonary aspergillosis (CAPA) is burdened by high mortality. Data are lacking about non-ICU patients. Aims of this study were to: (i) assess the incidence and prevalence CAPA in a respiratory sub-intensive care unit, (ii) evaluate its risk factors (iii) impact on in-hospital Secondary aims associated to mortality, significant features hematological Materials methods This was single-center, retrospective COVID-19 patients with acute failure. A cohort compared non-CAPA cohort. Among CAPA, further another non-hematological Results Three hundred fifty included study. Median P/F ratio at admission unit 225 mmHg (IQR 155–314). 55 (15.7%) developed (incidence 5.5%). Eighteen had probable (37.3%), 37 (67.3%) possible none proven CAPA. Diagnosis occurred median 17 days 12–31) from SARS-CoV-2 infection. Independent for malignancy [OR 1.74 (95%CI 0.75–4.37), p = 0.0003], lymphocytopenia 2.29 1.12–4.86), 0.02], COPD 2.74 1.19–5.08), 0.014]. Mortality rate higher (61.8% vs 22.7%, < 0.0001). resulted an independent factor mortality 2.92 1.47–5.89), 0.0024]. patients, age > 65 years predictor 5.09 (95% CI 1.20–26.92), 0.035]. No differences observed Conclusion life-threatening condition rates. It should be promptly suspected, especially case malignancy, lymphocytopenia.

Language: Английский

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Risk factors and clinical impact of COVID-19-associated pulmonary aspergillosis: Multicenter retrospective cohort study

The Korean Journal of Internal Medicine, Journal Year: 2022, Volume and Issue: 37(4), P. 851 - 863

Published: May 25, 2022

The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, no data have been reported in Korea. This study aimed to investigate the epidemiology importance CAPA diagnostic efforts identify predictors on outcomes.Between January 2020 May 2021, severely critically ill COVID-19 patients were extracted from seven hospitals Catholic Medical Center through a warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day mean daily duration use.A 2,427 screened, 218 included. diagnosed 4.6% (10/218) all hospitalized 11.2% (10/89) intensive care unit patients. Total dose (over 1,000 mg as methylprednisolone) high-dose corticosteroid 60 mg/day) independent but not 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 8.571) nor prolonged (OR, 2.794; CI, 0.635 13.928). In-hospital overall mortality 11.9% (26 218). itself did affect outcome; rather, steroid significantly increased 30-day (hazard ratio, 5.645; 1.225 26.091).CAPA uncommon, especially Daily predictor associated with high rates. High-dose corticosteroids after inflammatory phase should be avoided, active surveillance methods for are essential those high-risk

Language: Английский

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Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Pulmonary Aspergillosis in Critically Ill Patients: A Nationwide, Multicenter, Retrospective Cohort Study

Journal of Korean Medical Science, Journal Year: 2022, Volume and Issue: 37(18)

Published: Jan. 1, 2022

Coronavirus disease 2019 (COVID-19) is often accompanied by secondary infections, such as invasive aspergillosis. In this study, risk factors for developing COVID-19-associated pulmonary aspergillosis (CAPA) and their clinical outcomes were evaluated.This multicenter retrospective cohort study included critically ill COVID-19 patients from July 2020 through March 2021. Critically defined requiring high-flow respiratory support or mechanical ventilation. CAPA was based on the European Confederation of Medical Mycology International Society Human Animal consensus criteria. Factors associated with analyzed, adjusted a propensity score-matched model.Among 187 eligible patients, 17 (9.1%) developed CAPA, which equal to 33.10 per 10,000 patient-days. Sixteen received voriconazole-based antifungal treatment. addition, 82.4% 53.5% without respectively, early high-dose corticosteroids (P = 0.022). multivariable analysis, initial 10-day cumulative steroid dose > 60 mg dexamethasone equivalent dose) (adjusted odds ratio [OR], 3.77; 95% confidence interval [CI], 1.03-13.79) chronic OR, 4.20; CI, 1.26-14.02) independently CAPA. Tendencies higher 90-day overall mortality (54.3% vs. 35.2%, P 0.346) lower support-free rate observed in (76.3% 54.9%, 0.089).Our showed that corticosteroid use might be factor development possibility contributing adverse patients.

Language: Английский

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COVID-19-associated fungal infections in Iran: A systematic review

PLoS ONE, Journal Year: 2022, Volume and Issue: 17(7), P. e0271333 - e0271333

Published: July 11, 2022

Objectives This systematic review aims to summarize the mycological and clinical features of COVID-19-associated fungal infections (CAFIs) in Iran. Methods PubMed, Web Science, Scopus, Cochrane Library, SID, Magiran, IranDoc, Google Scholar were searched for Persian English articles published from January 1, 2020, November 5, 2021, using a search strategy. Studies on Iranian patients suffering CAFIs included review. Results Twenty-two studies comprising 169 retrieved. Reported candidiasis (85, 50.30%), mucormycosis (35, 20.71%), aspergillosis (29, 17.16%), fusariosis (6, 3.55%), three cases caused by rare pathogens (Rhodotorula mucilaginosa , Diaporthe foeniculina Sarocladium kiliense ) 11 (6.51%) uncharacterized mold infections. The most common underlying diseases diabetes (67/168, 39.88%), cardiovascular (55/168, 32.74%), hypertension (43/168, 25.59%). use antibiotics (111/124, 89.52%), corticosteroids (93/132, 70.44%), mechanical ventilation (66, 51.16%) predisposing factors. Totally, 72 (50.35%) 143 with died (data not available 26 patients). Conclusion Fungal are evident be complication COVID-19 Iran; thus, clinicians should consider them as differential diagnosis, especially comorbidities previous antibiotic or corticosteroid use.

Language: Английский

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Effect of glucocorticoids on the development of COVID‐19‐associated pulmonary aspergillosis: A meta‐analysis of 21 studies and 5174 patients

Mycoses, Journal Year: 2023, Volume and Issue: 66(11), P. 941 - 952

Published: Aug. 7, 2023

Abstract COVID‐19‐associated pulmonary aspergillosis (CAPA) remains a high mortality mycotic infection throughout the pandemic, and glucocorticoids (GC) may be its root cause. Our aim was to evaluate effect of systemic GC treatment on development CAPA. We systematically searched PubMed, Google Scholar, Scopus Embase databases collect eligible studies published until 31 December 2022. The pooled outcome CAPA calculated as log odds ratio (LOR) with 95% confidence intervals (CI) using random model. A total 21 5174 patients were included. Of these, 20 4675 consisting 2565 treated but without other immunomodulators (GC group) 2110 or (controls) analysed. LOR higher for group than controls (0.54; CI: 0.22, 0.86; p < .01). In subgroups, high‐dose (0.90; 0.17, 1.62: = .01) dexamethasone (0.71; 0.35, 1.07; had no significant difference low‐dose (0.41; −0.07, 0.89; .09), non‐dexamethasone (0.21; −0.36, 0.79; .47), versus controls. increases risk development, this is particularly associated use treatment.

Language: Английский

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