Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study
- PMID: 33730058
- PMCID: PMC7968651
- DOI: 10.1371/journal.pone.0238825
Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study
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.
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


Similar articles
-
Microbiological diagnosis of pulmonary invasive aspergillosis in critically ill patients with severe SARS-CoV-2 pneumonia: a bronchoalveolar study.Ann Clin Microbiol Antimicrob. 2023 Oct 10;22(1):90. doi: 10.1186/s12941-023-00626-7. Ann Clin Microbiol Antimicrob. 2023. PMID: 37817167 Free PMC article.
-
COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City.Med Mycol. 2021 Jul 14;59(8):828-833. doi: 10.1093/mmy/myab009. Med Mycol. 2021. PMID: 33724423 Free PMC article.
-
Comparison of 1,3-β-d-glucan with galactomannan in serum and bronchoalveolar fluid for the detection of Aspergillus species in immunosuppressed mechanical ventilated critically ill patients.J Crit Care. 2016 Dec;36:259-264. doi: 10.1016/j.jcrc.2016.06.026. Epub 2016 Jul 9. J Crit Care. 2016. PMID: 27475024
-
Comparing the clinical characteristics and outcomes of COVID-19-associate pulmonary aspergillosis (CAPA): a systematic review and meta-analysis.Infection. 2022 Feb;50(1):43-56. doi: 10.1007/s15010-021-01701-x. Epub 2021 Sep 27. Infection. 2022. PMID: 34570355 Free PMC article. Review.
-
Invasive pulmonary aspergillosis associated with viral pneumonitis.Curr Opin Microbiol. 2021 Aug;62:21-27. doi: 10.1016/j.mib.2021.04.006. Epub 2021 May 23. Curr Opin Microbiol. 2021. PMID: 34034082 Review.
Cited by
-
Pathogenesis and Pathology of COVID-Associated Mucormycosis: What Is New and Why.Curr Fungal Infect Rep. 2022;16(4):206-220. doi: 10.1007/s12281-022-00443-z. Epub 2022 Sep 29. Curr Fungal Infect Rep. 2022. PMID: 36193101 Free PMC article. Review.
-
Risk Factors for Coronavirus Disease 2019 (COVID-19)-Associated Pulmonary Aspergillosis in Critically Ill Patients: A Nationwide, Multicenter, Retrospective Cohort Study.J Korean Med Sci. 2022 May 9;37(18):e134. doi: 10.3346/jkms.2022.37.e134. J Korean Med Sci. 2022. PMID: 35535369 Free PMC article.
-
COVID-19-associated pulmonary aspergillosis (CAPA): Risk factors and development of a predictive score for critically ill COVID-19 patients.Mycoses. 2022 May;65(5):541-550. doi: 10.1111/myc.13434. Epub 2022 Mar 15. Mycoses. 2022. PMID: 35212030 Free PMC article.
-
Pathogenesis of Respiratory Viral and Fungal Coinfections.Clin Microbiol Rev. 2022 Jan 19;35(1):e0009421. doi: 10.1128/CMR.00094-21. Epub 2021 Nov 17. Clin Microbiol Rev. 2022. PMID: 34788127 Free PMC article. Review.
-
Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis.BMC Infect Dis. 2024 Feb 19;24(1):220. doi: 10.1186/s12879-024-09109-2. BMC Infect Dis. 2024. PMID: 38373908 Free PMC article.
References
-
- Donnelly JP, Chen SC, Kauffman CA, et al.. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin Infect Dis. 2019; 10.1093/cid/ciz1008 - DOI - PMC - PubMed
MeSH terms
Substances
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical