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. 2022 Jul;65(7):724-732.
doi: 10.1111/myc.13466. Epub 2022 May 25.

A screening study for COVID-19-associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic

Berrin Er  1 , Ahmet Görkem Er  2 , Dolunay Gülmez  3 , Taha Koray Şahin  4 , Burçin Halaçlı  1 , Gamze Durhan  5 , Ebru Ortaç Ersoy  1 , Alpaslan Alp  3 , Gökhan Metan  2 , Zeynep Saribas  3 , Sevtap Arikan-Akdagli  3 , Gülşen Hazırolan  3 , Seda Banu Akıncı  6 , Macit Arıyürek  5 , Arzu Topeli  1 , Ömrüm Uzun  2
Affiliations

A screening study for COVID-19-associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic

Berrin Er et al. Mycoses. 2022 Jul.

Abstract

Background: COVID-19-associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves.

Objectives: We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic.

Patients/methods: This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID-19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS-CoV-2 PCR-positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases.

Results: A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001).

Conclusions: One fifth of critically ill patients in COVID-19 ICUs developed CAPA, and this was associated with a high mortality.

Keywords: CAPA; COVID-19; aspergillus; critical care; incidence; intensive care; risk factors; screening.

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Conflict of interest statement

GM gave payment for presentations from Gilead, Pfizer, Merck, Sharp, and Dohme (MSD), 3 M, support for attending meetings from Gilead, Pfizer. SAA gave payment for presentation from Gilead, support for attending meetings Astellas. SBA gave multiple honoraria for lectures unrelated to the manuscript from own university. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Screening protocol. The first samples were obtained on Day 7 of SARS‐CoV‐2 PCR positivity, or in 48 h of ICU admission if positivity was detected >7 days. ICU, intensive care unit; GM, galactomannan and NBL, nondirected bronchial lavage
FIGURE 2
FIGURE 2
Flow chart of the study population. ICU, intensive care unit; IPA, invasive pulmonary aspergillosis and CAPA, COVID‐19‐associated pulmonary aspergillosis
FIGURE 3
FIGURE 3
Survival at 60 days follow‐up according to CAPA. CAPA: COVID‐19‐associated pulmonary aspergillosis, Pb: probable, poss: possible and ICU: intensive care unit
FIGURE 4
FIGURE 4
Survival at ICU discharge according to anti‐mould treatment
See this image and copyright information in PMC

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