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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The Impact of Corticosteroids on the Outcome of Fungal Disease: a Systematic Review and Meta-analysis

Current Fungal Infection Reports, Journal Year: 2023, Volume and Issue: 17(1), P. 54 - 70

Published: Feb. 23, 2023

Corticosteroids have a complex relationship with fungal disease - risk for many, benefit others. This systematic review aims to address the effect of corticosteroids on mortality and visual outcome in different diseases.Corticosteroids are factor aspergillosis patients who COVID-19, they also led worse outcome. Similarity, candidemia mucormycosis. Some researchers reported that using topical corticosteroid keratitis was associated if keratitis. studies showed linked negative non-HIV Pneumocystis jirovecii pneumonia (PCP), contrast those HIV PCP.In 59 references, we found therapy clinical invasive (IA) (HR: 2.50, 95%CI: 1.89-3.31, p < 0.001) chronic pulmonary (CPA) 2.74, 1.48-5.06, = 0.001), PCP without infection (OR: 1.29, 1.09-1.53, 0.003), candidiasis candidaemia 2.13, 1.85-2.46, mucormycosis 4.19, 1.74-10.05, early course 2.99, 1.14-7.84, 0.026). There equivocal cryptococcal meningoencephalitis AIDS primary coccidioidomycosis, while better HIV-infected (RR: 0.62, 0.46-0.83, p=0.001) after keratoplasty surgery 0.01, 0.00-0.41, 0.041) probably non-immunocompromised patients. A sub-analysis CPA use more than 2 mg/kg/day prednisolone equivalents per day is significant increasing 2.94, 2.13-4.05, 0.001). Corticosteroid during usually slightly or greatly increased (in keratitis), two exceptions. Avoiding addition corticosteroids, minimising dose duration require them, likely improve most life- vision-threatening diseases. provides cornerstone further research exploring accuracy suitable treatment diseases.The online version contains supplementary material available at 10.1007/s12281-023-00456-2.

Language: Английский

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Severe mold fungal infections in critically ill patients with COVID-19

Future Microbiology, Journal Year: 2024, Volume and Issue: 19(9), P. 825 - 840

Published: May 31, 2024

The SARS-CoV-2 pandemic put an unprecedented strain on modern societies and healthcare systems. A significantly higher incidence of invasive fungal co-infections was noted compared with the pre-COVID-19 era, adding new diagnostic therapeutic challenges in critical care setting. In current narrative review, we focus mold infections caused by Aspergillus Mucor species critically ill COVID-19 patients. We discuss up-to-date information incidence, pathogenesis, diagnosis treatment these mold-COVID-19 co-infections, as well recommendations preventive prophylactic interventions. Traditional risk factors were often not recognized COVID-19-associated aspergillosis mucormycosis, highlighting role other determinant factors. associated patient outcomes worse patients without co-infection.

Language: Английский

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Genetic relationships of Aspergillus fumigatus in hospital settings during COVID-19

Microbiology Spectrum, Journal Year: 2025, Volume and Issue: unknown

Published: April 2, 2025

ABSTRACT The transmission pathways and risks of COVID-19-associated pulmonary aspergillosis (CAPA) remain unclear. This study investigated the genetic relationships Aspergillus fumigatus isolates from patients with without COVID-19 environmental air samples to suggest possible patterns. We conducted a prospective March 2020 December 2022, collecting clinical tertiary hospital. Isolates were compared those at four hospital locations. analysis included internal transcribed spacer β-tubulin A sequencing, azole resistance assessed via cyp51A gene analysis. Multiple locus variable-number tandem repeat was performed elucidate relationships. total 155 (19 patients, 104 non-COVID-19 32 samples) identified genotyped, revealing 131 sequence types (Simpson Diversity Index 0.9972). Four CAPA strains genetically related isolated intensive care unit (ICU), while two sharing multiple azole-resistant mutations in same ICU 4 months apart. All but one these requiring mechanical ventilation. observed similarities between critically ill environment, as well within ICU, raise possibility nosocomial acquisition contaminated or sources. These findings highlight associated negative pressure rooms need for enhanced infection control measures. IMPORTANCE reveals links sources, suggesting urging reevaluation universal isolation practices hospitals, especially patients.

Language: Английский

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Environmental Mold Management in Negative‐Pressure Isolation Wards During the COVID‐19 Pandemic: A Potential Indicator of COVID‐19‐Associated Pulmonary Aspergillosis

Indoor Air, Journal Year: 2025, Volume and Issue: 2025(1)

Published: Jan. 1, 2025

High concentration of mold spores in inhaled air is an important risk factor for invasive infections. COVID‐19 (coronavirus disease 2019)‐associated pulmonary aspergillosis (CAPA) a serious complication severe COVID‐19. To investigate the distribution negative‐pressure isolation wards and its potential association with CAPA incidence, we conducted microbiological sampling retrospectively analyzed cases tertiary care hospital Korea during pandemic. Air was January 2022 at multiple sites four designated managing patients. A portable microbial sampler (MAS‐100 NT) used sampling, Tryptic Soy Agar plates were incubated to identify isolates genus level. (January 2021–June 2023) defined by antifungal treatment, mycological evidence (serum galactomannan index > 0.5), radiological findings. Immunomodulator use, including dexamethasone tocilizumab, clinical factors influencing incidence. Among isolated molds, Aspergillus (86.7%) most prevalent, followed Penicillium (53.3%), Mucorales (20%), Paecilomyces (13.3%). Mold concentrations highest areas adjacent construction site. Intervention procedures, installing purifiers reinforcing seals between adjoining site ward, effectively reduced paralleled decline While increased foot traffic after relaxation restriction measures led rise spore concentration, incidence did not increase, likely due decreased use immunomodulators such as corticosteroids tocilizumab. Construction‐related increases can be mitigated appropriate interventions, pedestrian near may need regulation. Monitoring mitigating environmental contamination are crucial preventing opportunistic respiratory infections should interpreted conjunction factors.

Language: Английский

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The clinical impact of prolonged steroid therapy in severe COVID-19 patients: a retrospective cohort study with propensity score matching

BMC Pulmonary Medicine, Journal Year: 2025, Volume and Issue: 25(1)

Published: May 8, 2025

The optimal duration of steroid therapy for patients with COVID-19 remains unclear. This study compared clinical outcomes between early withdrawal (EW; ≤10 days) and prolonged tapering (PT; >10 in severe requiring oxygen support. retrospective, single-center cohort included adult WHO-CPS scores 6-9 admitted to a tertiary hospital Seoul, Republic Korea. After 1:1 propensity score matching, 68 were each group. Primary 28-day 60-day mortality. Secondary aggravation, rebound pneumonia, infectious complications, readmission or emergency department (ED) revisits, support, lengths hospitalization ICU stay. Baseline characteristics well balanced after matching. No significant differences observed mortality (5.9% vs. 10.3%, HR 0.54, 95% CI 0.16-1.84, p = 0.32) (14.7% 11.8%, 1.22, 0.48-3.10, 0.67) PT EW groups. Rates ED revisit also comparable. However, the group had significantly longer durations support (17.5 13.0 days, 0.001), (20.0 14.0 stay (5.0 1.0 0.01). Prolonged beyond 10 days did not improve survival other COVID-19, suggesting that may be appropriate selected patients.

Language: Английский

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Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis

Journal of Fungi, Journal Year: 2023, Volume and Issue: 9(6), P. 689 - 689

Published: June 20, 2023

A review of 38 studies involving 1437 COVID-19 patients admitted to intensive care units (ICUs) with pulmonary aspergillosis (CAPA) was conducted investigate whether mortality has improved since the pandemic’s onset. The study found that median ICU 56.8%, ranging from 30% 91.8%. These rates were higher for during 2020–2021 (61.4%) compared 2020 (52.3%), and prospective (64.7%) than retrospective ones (56.4%). in various countries used different criteria define CAPA. percentage who received antifungal therapy varied across studies. results indicate rate among CAPA is a growing concern, mainly there been an overall reduction patients. Urgent action needed improve prevention management strategies CAPA, additional research identify optimal treatment reduce these This serves as call healthcare professionals policymakers prioritize serious potentially life-threatening complication COVID-19.

Language: Английский

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Pulmonary Aspergillosis in Critically Ill COVID-19 Patients Admitted to the Intensive Care Unit: A Retrospective Cohort Study

Journal of Fungi, Journal Year: 2023, Volume and Issue: 9(3), P. 315 - 315

Published: March 3, 2023

COVID-19-associated pulmonary aspergillosis (CAPA) is a life-threatening fungal infection that mainly affects critically ill patients. The aim of this study was to assess the incidence and clinical outcomes putative CAPA in COVID-19 This retrospective observational cohort included 181 cases from 5 ICUs at Vienna General Hospital between January 2020 April 2022. Patients were diagnosed with according AspICU classification, which positive Aspergillus culture bronchoalveolar lavage sample, compatible signs symptoms, abnormal medical imaging. primary outcome adjusted 60-day all-cause mortality ICU admission patients vs. without CAPA. Secondary time diagnosis pathogen prevalence distribution. Putative identified 35 (19.3%) mean 9 days. Death 60 days occurred 18 (51.4%) 43 146 (29.5%) (adjusted HR (95%CI) = 2.15 (1.20-3.86, p 0.002). most frequently isolated species fumigatus. high associated significantly higher mortality.

Language: Английский

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Risk factors and the value of microbiological examinations of COVID-19 associated pulmonary aspergillosis in critically ill patients in intensive care unit: the appropriate microbiological examinations are crucial for the timely diagnosis of CAPA

Frontiers in Cellular and Infection Microbiology, Journal Year: 2023, Volume and Issue: 13

Published: Nov. 21, 2023

Introduction During the Omicron pandemic in China, a significant proportion of patients with Coronavirus Disease 2019 (COVID-19) associated pulmonary aspergillosis (CAPA) necessitated admission to intensive care unit (ICU) and experienced high mortality. To explore clinical risk factors application/indication microbiological examinations CAPA ICU for timely diagnosis are very important. Methods This prospective study included COVID-19 admitted between December 1, 2022, February 28, 2023. The data influenza-associated (IAPA) from past five consecutive influenza seasons (November 2017, March 31, 2022) were collected comparison. types specimens methods used also recorded efficacy early diagnosis. Results Among 123 patients, 36 (29.3%) diagnosed probable CAPA. more immunosuppressed, serious condition, required advanced respiratory support had other organ comorbidities. Solid transplantation, APACHEII score ≥20 points, 5 points ≤SOFA &lt;10 independent Qualified lower tract obtained all 84/123 (68.3%) underwent bronchoscopy obtain bronchoalveolar lavage fluid (BALF) specimens. All patients’ fungal smear culture; 79/123 (64.2%) 69/123 (56.1%) BALF galactomannan (GM) serum GM detection, respectively; metagenomic next-generation sequencing (mNGS) was performed 62/123 (50.4%) patients. highest diagnostic sensitivity (84.9%), area under curve mNGS (0.812). Conclusion incidence extremely ICU. mainly depends on evidence owing non-specific manifestations, routine laboratory examinations, CT findings. should be as soon possible. most suitable Due accuracy result mNGS, it could assist might an option critically ill

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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