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. 2021 Jun;64(6):641-650.
doi: 10.1111/myc.13259. Epub 2021 Mar 5.

Systematic screening for COVID-19 associated invasive aspergillosis in ICU patients by culture and PCR on tracheal aspirate

Rebecca van Grootveld  1 , Judith van Paassen  2 , Mark G J de Boer  3 , Eric C J Claas  1 , Ed J Kuijper  4 , Martha T van der Beek  5 ; LUMC-COVID-19 Research Group
Affiliations

Systematic screening for COVID-19 associated invasive aspergillosis in ICU patients by culture and PCR on tracheal aspirate

Rebecca van Grootveld et al. Mycoses. 2021 Jun.

Abstract

Background: A high prevalence of COVID-19 associated pulmonary aspergillosis (CAPA) has been reported, though histopathological evidence is frequently lacking. To assess the clinical significance of Aspergillus species in respiratory samples of mechanically ventilated COVID-19 patients, we implemented routine screening for Aspergillus in tracheal aspirate (TA).

Patients/methods: From all adult COVID-19 patients admitted to the intensive care unit (ICU), TA samples were collected twice a week for Aspergillus screening by PCR and or culture. Bronchoalveolar lavage (BAL) sampling was performed in patients with a positive screening result if possible. Clinical information was obtained from the electronic patient record and patients were categorised according to the recently published consensus case definition for CAPA.

Results: Our study population consisted of 63 predominantly (73%) male patients, with a median age of 62 years and total median ICU stay of 18 days. Aspergillus species were present in TA screening samples from 15 patients (24%), and probable CAPA was diagnosed in 11 (17%) patients. Triazole resistance was detected in one patient (14%). Concordance between TA and BAL was 86%, and all TA culture positives were confirmed in BAL. We were able to withhold treatment in three of fifteen patients with positive screening (20%) but negative BAL results.

Conclusions: Positive culture, molecular detection and or antigen detection of Aspergillus species do not equal infection. Until we understand the clinical relevance of Aspergillus species detected in respiratory samples of COVID-19 patients, minimal-invasive screening by TA is a feasible method to monitor patients. Positive screening results should be an indication to perform a BAL to rule out upper airway colonisation.

Keywords: Aspergillus; COVID-19; COVID-19 associated pulmonary aspergillosis; intensive care unit; invasive fungal infections; invasive pulmonary aspergillosis; screening.

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Figures

FIGURE 1
FIGURE 1
Screening for and classification of COVID‐19 associated pulmonary aspergillosis. TA, tracheal aspirate; BAL, bronchoalveolar lavage; CAPA, COVID‐19 associated pulmonary aspergillosis; GM, galactomannan; pos: positive; neg, negative. Patients were classified according to the CAPA consensus definition.20. †BAL sampling was performed in patients with negative screening results if there was a clinical indication, respiratory deterioration for example. ‡One of the patients with probable CAPA had a positive cytological smear of BAL showing branching hyphae. §In one of the patients branching hyphae were seen in a TA Gram stain
FIGURE 2
FIGURE 2
Cumulative incidence of positive screening results from ICU admission. Positive screening result: tracheal aspirate PCR or culture positive. Follow‐up time for patients with negative screening was until last negative culture and or PCR
See this image and copyright information in PMC

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