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. 2023 Feb 22;9(3):288.
doi: 10.3390/jof9030288.

Anticipatory Antifungal Treatment in Critically Ill Patients with SARS-CoV-2 Pneumonia

Ángel Estella  1 , María Recuerda Núñez  1 , Carolina Lagares  2 , Manuel Gracia Romero  1 , Eva Torres  3 , Juan Carlos Alados Arboledas  3 , Álvaro Antón Escors  4 , Clara González García  4 , Dolores Sandar Núñez  1 , Dolores López Prieto  3 , Juan Manuel Sánchez Calvo  3
Affiliations

Anticipatory Antifungal Treatment in Critically Ill Patients with SARS-CoV-2 Pneumonia

Ángel Estella et al. J Fungi (Basel). .

Abstract

Background: The aim of this study was to investigate the incidence of COVID-19-associated pulmonary aspergillosis (CAPA) in critically ill patients and the impact of anticipatory antifungal treatment on the incidence of CAPA in critically ill patients.

Methods: Before/after observational study in a mixed intensive care unit (ICU) of a university teaching hospital. The study took place between March 2020 and June 2022. Inclusion criteria were critically ill patients with severe SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. Two analysis periods were compared according to whether or not antifungal therapy was given early.

Results: A total of 160 patients with severe SARS-CoV-2 pneumonia and invasive mechanical ventilation were included. The incidence of CAPA in the first study period was 19 out of 58 patients (32.75%); during the second period, after implementation of the intervention (anticipatory antifungal therapy), the incidence of CAPA decreased to 10.78% (11 out of 102 patients). In patients with CAPA under invasive mechanical ventilation, the mortality rate decreased from 100% to 64%.

Conclusions: Anticipating antifungal treatment in patients with SARS-CoV-2 pneumonia under invasive mechanical ventilation was associated with a decrease in the incidence and mortality of pulmonary aspergillosis.

Keywords: ARDS; ICU; SARS-CoV-2; aspergillus; bronchoalveolar lavage; liposomal amphotericin B.

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Conflict of interest statement

AE has participated in presentations/training activities organized by Pfizer, Gilead, MSD. The other authors declare they have no conflicts of interest. No funder was involved in the design, data collection, analyses or interpretation of this study, in the writing of the manuscript, or in the decision to publish the results. INIBICA, through a grant obtained from GILEAD, collaborated in the financing of the publication fee.

Figures

Figure 1
Figure 1
Block diagram showing the algorithm to guide clinical decision during the second period of the study.
Figure 2
Figure 2
Overall mortality at 90 days from ICU admission in patients with SARS-CoV-2 infection with and without early antifungal treatment at ICU admission.
Figure 3
Figure 3
(a) Mortality at 90 days from ICU admission in patients with SARS-CoV-2 infection and early antifungal treatment at ICU admission. (b) 90-day mortality from ICU admission in patients with SARS-CoV-2 infection without early antifungal treatment at ICU admission.
Figure 3
Figure 3
(a) Mortality at 90 days from ICU admission in patients with SARS-CoV-2 infection and early antifungal treatment at ICU admission. (b) 90-day mortality from ICU admission in patients with SARS-CoV-2 infection without early antifungal treatment at ICU admission.
See this image and copyright information in PMC

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