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. 2022 Mar 8;8(3):273.
doi: 10.3390/jof8030273.

Routine Surveillance of Healthcare-Associated Infections Misses a Significant Proportion of Invasive Aspergillosis in Patients with Severe COVID-19

Julia Ebner  1 , Miriam Van den Nest  1 , Lukas Bouvier-Azula  1 , Astrid Füszl  1 , Cornelia Gabler  2 , Birgit Willinger  3 , Magda Diab-Elschahawi  1 , Elisabeth Presterl  1
Affiliations

Routine Surveillance of Healthcare-Associated Infections Misses a Significant Proportion of Invasive Aspergillosis in Patients with Severe COVID-19

Julia Ebner et al. J Fungi (Basel). .

Abstract

Rates of invasive aspergillosis (IA) among COVID-19 ICU patients seem to reach over 30% in certain settings. At Vienna General Hospital (VGH), all rooms in COVID-19 ICUs were put under negative pressure as a protective measure, thus increasing the risk of exposure to environmental pathogens for patients. Even though all ICU patients are surveilled for healthcare-associated infections (HAI), there were concerns that the routine protocol might not be sufficient for IA detection. We reviewed the electronic patient charts of all patients with COVID-19 admitted to ICUs between 1 March 2020 and 31 July 2021 for fungal co- or superinfections, comparing four diagnostic algorithms based on different recommendations for the diagnosis of IA (according to EORTC/MSG, BM-AspICU, IAPA and CAPA) to our routine surveillance protocol. We found that out of 252 patients who were admitted to the ICU during the study period, 25 (9.9%) fulfilled the criteria of probable or possible IA of at least one algorithm. The IAPA definitions detected 25 and the CAPA definition 23 probable and 2 possible cases, out of which only 16 were classified as hospital-acquired IA by routine surveillance. In conclusion, adjustment of the routine protocol using a classification system especially designed for respiratory viral illness seems useful for the surveillance of IA in a highly vulnerable patient cohort.

Keywords: COVID-19; intensive care; invasive aspergillosis; superinfection; surveillance.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Ground plan of VGH, (b) photo of demolition site, BT = building.
Figure 2
Figure 2
Network diagram of diagnostic criteria. Abbreviations: BM-AspICU = Biomarker-invasive aspergillosis in ICU; CAPA = COVID-19-associated pulmonary aspergillosis; EORTC/MSG = European Organization for the Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium; HAI-ICU = ECDC HAI-Net ICU protocol, vs. 2.2; IAPA = Influenza-associated pulmonary aspergillosis.
Figure 3
Figure 3
Epidemic curve of COVID-19 cases at ICU (area; y-axis on the left) and COVID-19 plus IA cases at ICU (bars; y-axis on the right); frame gives period of demolition work.
Figure 4
Figure 4
UpSet plot of diagnostic tests. Abbreviations: BDG = β-D-Glucan assay from serum; GM = Galactomannan assay; PCR = Polymerase chain reaction.
See this image and copyright information in PMC

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