Covid-19-associated pulmonary aspergillosis in mechanically ventilated patients: incidence and outcome in a French multicenter observational cohort (APICOVID)

Annals of Intensive Care, Journal Year: 2024, Volume and Issue: 14(1)

Published: Jan. 29, 2024

Abstract Background Recent studies identified coronavirus disease 2019 (COVID-19) as a risk factor for invasive pulmonary aspergillosis (IPA) but produced conflicting data on IPA incidence and impact patient outcomes. We aimed to determine the outcomes of COVID-19-associated (CAPA) in mechanically ventilated patients. Methods performed multicenter retrospective observational cohort study consecutive adults admitted 15 French intensive care units (ICUs) 2020 COVID-19 requiring mechanical ventilation. CAPA was diagnosed graded according ECMM/ISHAM consensus criteria. The primary objective proven/probable CAPA, secondary objectives were identify factors assess associations between Results 708 included patients (522 [73.7%] men) had mean age 65.2 ± 10.8 years, median ventilation duration 15.0 [8.0–27.0] days, day-90 mortality rate 28.5%. Underlying immunosuppression present 113 (16.0%) Corticosteroids used 348 (63.1%) Criteria probable met by 18 (2.5%) patients; no histologically proven CAPA. Older only significantly associated with (hazard ratio [HR], 1.04; 95% CI 1.00–1.09; P = 0.04). Probable higher (HR, 2.07; 1.32–3.25; 0.001) not longer or ICU length stay. Conclusion is rare serious complication severe mortality. Graphical

Language: Английский

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Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis

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

Published: Feb. 19, 2024

Abstract Background Invasive Aspergillosis (IA) is a life-threatening fungal disease with significant mortality rates. Timely diagnosis and treatment greatly enhance patient outcomes. This study aimed to explore the association between age development of IA, as well potential implications for risk stratification strategies. Methods We searched National Center Biotechnology Information (NCBI) databases publications until October 2023 containing characteristics patients without IA. A random-effects model application inverse-variance weighting was used pool reported estimates from each study, meta-regression subgroup analyses were utilized assess sources heterogeneity. Results systematic review conducted, resulting in inclusion 55 retrospective observational studies total 13,983 patients. Meta-analysis revealed that, on average, IA approximately two half years older (95% Confidence Interval [CI] 1.84–3.31 years; I 2 = 26.1%) than those ( p < 0.0001). No moderators could explain observed heterogeneity difference. However, analysis that differences more pronounced within particular groups compared others. For example, who had primary severe lung infections exhibited greater difference mean other cohorts. Conclusions Further research, such individual data meta-analysis, necessary better understand relationship increasing likelihood Improved strategies based potentially early detection ultimately improving

Language: Английский

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The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study

Scientific Reports, Journal Year: 2024, Volume and Issue: 14(1)

Published: March 3, 2024

This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020-15 August 2021. A total 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled inclusion criteria were included study. One-month mortality rate (OMM) 44.8%. The logistic regression analysis showed following significant variables for mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum 5 days favipiravir (p = 0.005, OR 5.166, 95% CI 1.639-16.280); (ii) need ICU: glycopeptide therapy at any time during COVID-19/FEN episode 0.001, 6.566, 2.137-20.172), mechanical ventilation < 62.042, 9.528-404.011); (iii) ventilation: failure recover from neutropenia 17.869, 3.592-88.907), tocilizumab 0.028, 32.227, 1.469-707.053), septic shock 15.4 96% 3.164-75.897), ICU 91.818, 15.360-548.873), (iv) OMM: [mechanical 19.041, 3.229-112.286) 0.010, 5.589,95% 1.509-20.700)]. Although it includes relatively limited number patients, our findings suggest COVID-19 FEN are associated morbidity.

Language: Английский

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COVID‐19‐associated aspergillosis in a Brazilian referral centre: Diagnosis, risk factors and outcomes

Mycoses, Journal Year: 2022, Volume and Issue: 65(4), P. 449 - 457

Published: Feb. 17, 2022

COVID-19 patients on mechanical ventilation are at risk to develop invasive aspergillosis. To provide additional data regarding this intriguing entity, we conducted a retrospective study describing factors, radiology and prognosis of emerging entity in Brazilian referral centre.This included intubated (≥18 years) with admitted from April 2020 until July 2021 that had bronchoscopy investigate pulmonary co-infections. COVID-19-associated aspergillosis (CAPA) was defined according the European Confederation Medical Mycology/International Society Human Animal Mycosis consensus criteria. The performance tracheal aspirate (TA) cultures diagnose CAPA were described, as well radiological findings, factors outcomes.Fourteen (14/87, 16%) probable (0.9 cases per 100 ICU admissions). sensitivity, specificity, positive predictive value negative TA for diagnosis 85.7%, 73.1%, 46.2% 95% respectively. Most findings classified typical (64.3%). overall mortality rate 71.4%. Age only independent factor [p = .03; odds ratio (OR) 1.072]. under renal replacement therapy (RRT) may have higher fatal outcome (p .053, hazard 8.047).CAPA prevalent co-infection our cohort ventilation. Older CAPA, poor be associated RRT.

Language: Английский

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Invasive aspergillosis in coronavirus disease 2019: a practical approach for clinicians

Current Opinion in Infectious Diseases, Journal Year: 2022, Volume and Issue: 35(2), P. 163 - 169

Published: Jan. 3, 2022

Purpose of review Invasive pulmonary aspergillosis (IPA) can affect patients with severe coronavirus disease 2019 (COVID-19), but many questions remain open about its very variable incidence across the world, actual link between viral infection and fungal superinfection, significance Aspergillus recovery in a respiratory sample, management such cases. This addresses these aims at providing some clues for practical diagnostic therapeutic approaches COVID-19-associated (CAPA) clinical perspective. Recent findings Definitions have been proposed possible/probable/proven CAPA, distinction colonization invasive is difficult not possible most cases absence histopathological proof or positive galactomannan serum. Most importantly, an by direct (culture, PCR) indirect (galactomannan) test sample indicator worse outcome, which justifies screening early detection initiation preemptive antifungal therapy Summary The COVID-19 pandemic has increased our awareness IPA among ICU patients. Although current recommendations are mainly based on experts’ opinions, prospective studies needed to get more evidence-based support approach CAPA.

Language: Английский

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