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. 2023 Mar 2;9(3):312.
doi: 10.3390/jof9030312.

Managing the Next Wave of Influenza and/or SARS-CoV-2 in the ICU-Practical Recommendations from an Expert Group for CAPA/IAPA Patients

Jose Peral  1 , Ángel Estella  2 , Xavier Nuvials  3 , Alejandro Rodríguez  4 , Iratxe Seijas  5 , Cruz Soriano  6 , Borja Suberviola  7 , Rafael Zaragoza  8
Affiliations

Managing the Next Wave of Influenza and/or SARS-CoV-2 in the ICU-Practical Recommendations from an Expert Group for CAPA/IAPA Patients

Jose Peral et al. J Fungi (Basel). .

Abstract

The aim of this study was to establish practical recommendations for the diagnosis and treatment of influenza-associated invasive aspergillosis (IAPA) based on the available evidence and experience acquired in the management of patients with COVID-19-associated pulmonary aspergillosis (CAPA). The CAPA/IAPA expert group defined 14 areas in which recommendations would be made. To search for evidence, the PICO strategy was used for both CAPA and IAPA in PubMed, using MeSH terms in combination with free text. Based on the results, each expert developed recommendations for two to three areas that they presented to the rest of the group in various meetings in order to reach consensus. As results, the practical recommendations for the management of CAPA/IAPA patients have been grouped into 12 sections. These recommendations are presented for both entities in the following situations: when to suspect fungal infection; what diagnostic methods are useful to diagnose these two entities; what treatment is recommended; what to do in case of resistance; drug interactions or determination of antifungal levels; how to monitor treatment effectiveness; what action to take in the event of treatment failure; the implications of concomitant corticosteroid administration; indications for the combined use of antifungals; when to withdraw treatment; what to do in case of positive cultures for Aspergillus spp. in a patient with severe viral pneumonia or Aspergillus colonization; and how to position antifungal prophylaxis in these patients. Available evidence to support the practical management of CAPA/IAPA patients is very scarce. Accumulated experience acquired in the management of CAPA patients can be very useful for the management of IAPA patients. The expert group presents eminently practical recommendations for the management of CAPA/IAPA patients.

Keywords: COVID-19; COVID-associated invasive aspergillosis; critical patients; influenza-associated invasive aspergillosis; intensive care unit.

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Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Schauwvlieghe A., Rijnders B.J.A., Philips N., Verwijs R., Vanderbeke L., Van Tienen C., Lagrou K., Verweij P.E., Van de Veerdonk F.L., Gommers D., et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study. Lancet Respir. Med. 2018;6:782–792. doi: 10.1016/S2213-2600(18)30274-1. - DOI - PubMed
    1. Reizine F., Pinceaux K., Lederlin M., Autier B., Guegan H., Gacouin A., Luque-Paz D., Boglione-Kerrien C., Bacle A., Le Daré B., et al. Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different? J. Fungi. 2021;7:388. doi: 10.3390/jof7050388. - DOI - PMC - PubMed
    1. White P.L., Dhillon R., Cordey A., Hughes H., Faggian F., Soni S., Pandey M., Whitaker H., May A., Morgan M., et al. A National Strategy to Diagnose Coronavirus Disease 2019—Associated Invasive Fungal Disease in the Intensive Care Unit. Clin. Infect. Dis. 2021;73:e1634–e1644. doi: 10.1093/cid/ciaa1298. - DOI - PMC - PubMed
    1. Bartoletti M., Pascale R., Cricca M., Rinaldi M., Maccaro A., Bussini L., Fornaro G., Tonetti T., Pizzilli G., Francalanci E., et al. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study. Clin. Infect. Dis. 2021;73:e3606–e3614. doi: 10.1093/cid/ciaa1065. - DOI - PMC - PubMed
    1. Koehler P., Cornely O.A., Böttiger B.W., Dusse F., Eichenauer D.A., Fuchs F., Hallek M., Jung N., Klein F., Persigehl T., et al. COVID-19 associated pulmonary aspergillosis. Mycoses. 2020;63:528–534. doi: 10.1111/myc.13096. - DOI - PMC - PubMed