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. 2021 Mar 17;16(3):e0238825.
doi: 10.1371/journal.pone.0238825. eCollection 2021.

Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study

Tobias Lahmer  1 , Silja Kriescher  2 , Alexander Herner  1 , Kathrin Rothe  3 , Christoph D Spinner  1 , Jochen Schneider  1 , Ulrich Mayer  1 , Michael Neuenhahn  3 , Dieter Hoffmann  4 , Fabian Geisler  1 , Markus Heim  2 , Gerhard Schneider  2 , Roland M Schmid  1 , Wolfgang Huber  1 , Sebastian Rasch  1
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Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study

Tobias Lahmer et al. PLoS One. .

Abstract

Background: Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia.

Methods: We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls.

Findings: CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA.

Interpretation: CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.

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Conflict of interest statement

Tobias T.L. received travel grants from Gilead, Pfizer and MSD. CDS received travel grants/honoraria from AbbVie, Gilead, Janssen, MSD and ViiV Healthcare. CDS received funding for clinical research from Gilead, Janssen and ViiV Healthcare. The received grants/funding were not related to the submitted manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Standardized diagnostic algorithm for patients with suspected or confirmed COVID-19 associated ARDS.
Fig 2
Fig 2
Results of regression models displayed by Forest Blots: A) Risk factors of invasive pulmonary aspergillosis in total patient cohort (COVID-19 patients and controls); B) Risk factors of invasive pulmonary aspergillosis in patients with COVID-19 (OR: odds ratio; 95% CI: 95% confidence interval; IL-6: interleukin -6).
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The author(s) received no specific funding for this work.