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. 2024 Apr 24;14(1):65.
doi: 10.1186/s13613-024-01296-0.

COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants

Pierre Bay  1   2   3   4 , Etienne Audureau  5   6   7 , Sébastien Préau  8 , Raphaël Favory  8 , Aurélie Guigon  9 , Nicholas Heming  10 , Elyanne Gault  11 , Tài Pham  12   13   14 , Amal Chaghouri  15 , Matthieu Turpin  16 , Laurence Morand-Joubert  17   18 , Sébastien Jochmans  19 , Aurélia Pitsch  20 , Sylvie Meireles  21 , Damien Contou  22 , Amandine Henry  23 , Adrien Joseph  24 , Marie-Laure Chaix  25   26 , Fabrice Uhel  27   28 , Damien Roux  27   28 , Diane Descamps  29 , Malo Emery  30 , Claudio Garcia-Sanchez  31 , David Levy  32 , Sonia Burrel  33   34 , Julien Mayaux  35 , Antoine Kimmoun  36   37 , Cédric Hartard  38 , Frédéric Pène  39 , Flore Rozenberg  40 , Stéphane Gaudry  41 , Ségolène Brichler  42 , Antoine Guillon  43 , Lynda Handala  44   45 , Fabienne Tamion  46 , Alice Moisan  47 , Thomas Daix  48 , Sébastien Hantz  49   50 , Flora Delamaire  51 , Vincent Thibault  52   53 , Bertrand Souweine  54 , Cecile Henquell  55 , Lucile Picard  56 , Françoise Botterel  5   57 , Christophe Rodriguez  5   58   57 , Armand Mekontso Dessap  59   12   5 , Jean-Michel Pawlotsky  5   58   57 , Slim Fourati #  5   58   57 , Nicolas de Prost #  59   12   5 ; SEVARVIR investigators
Collaborators, Affiliations

COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants

Pierre Bay et al. Ann Intensive Care. .

Erratum in

  • Correction: COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants.
    Bay P, Audureau E, Préau S, Favory R, Guigon A, Heming N, Gault E, Pham T, Chaghouri A, Turpin M, Morand-Joubert L, Jochmans S, Pitsch A, Meireles S, Contou D, Henry A, Joseph A, Chaix ML, Uhel F, Roux D, Descamps D, Emery M, Garcia-Sanchez C, Levy D, Burrel S, Mayaux J, Kimmoun A, Hartard C, Pène F, Rozenberg F, Gaudry S, Brichler S, Guillon A, Handala L, Tamion F, Moisan A, Daix T, Hantz S, Delamaire F, Thibault V, Souweine B, Henquell C, Picard L, Botterel F, Rodriguez C, Dessap AM, Pawlotsky JM, Fourati S, de Prost N; SEVARVIR investigators. Bay P, et al. Ann Intensive Care. 2024 Jun 14;14(1):87. doi: 10.1186/s13613-024-01318-x. Ann Intensive Care. 2024. PMID: 38874854 Free PMC article. No abstract available.

Abstract

Background: During the first COVID-19 pandemic wave, COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in up to 11-28% of critically ill COVID-19 patients and associated with increased mortality. As new SARS-CoV-2 variants emerged, the characteristics of critically ill COVID-19 patients have evolved, particularly in the era of Omicron. The purpose of this study is to investigate the characteristics of CAPA in the era of new variants.

Methods: This is a prospective multicenter observational cohort study conducted in France in 36 participating intensive care units (ICU), between December 7th, 2021 and April 26th 2023. Diagnosis criteria of CAPA relied on European Confederation of Medical Mycology (ECMM)/International Society for Human & Animal Mycology (ISHAM) consensus criteria.

Results: 566 patients were included over the study period. The prevalence of CAPA was 5.1% [95% CI 3.4-7.3], and rose to 9.1% among patients who required invasive mechanical ventilation (IMV). Univariable analysis showed that CAPA patients were more frequently immunosuppressed and required more frequently IMV support, vasopressors and renal replacement therapy during ICU stay than non-CAPA patients. SAPS II score at ICU admission, immunosuppression, and a SARS-CoV-2 Delta variant were independently associated with CAPA in multivariable logistic regression analysis. Although CAPA was not significantly associated with day-28 mortality, patients with CAPA experienced a longer duration of mechanical ventilation and ICU stay.

Conclusion: This study contributes valuable insights into the prevalence, characteristics, and outcomes of CAPA in the era of Delta and Omicron variants. We report a lower prevalence of CAPA (5.1%) among critically-ill COVID-19 patients than previously reported, mainly affecting intubated-patients. Duration of mechanical ventilation and ICU stay were significantly longer in CAPA patients.

Keywords: Acute respiratory distress syndrome; COVID-19; COVID-19 associated pulmonary aspergillosis; Intensive care unit; Invasive pulmonary aspergillosis; Omicron; SARS-CoV-2.

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Conflict of interest statement

S.F. has served as a speaker for GlaxoSmithKline, AstraZeneca, MSD, Pfeizer, Cepheid and Moderna. J.-M.P. has served as an advisor or speaker for Abbvie, Arbutus, Assembly Biosciences, Gilead and Merck. E.A. has received fees for lectures from Alexion, Sanofi, Gilead and Pfizer. His hospital has received research grant from Pfizer, MSD and Alexion. D.D. served as an advisor for Gilead-Sciences, ViiV Health care, Janssen-Cilag et MSD. F.P. served as an advisor for Gilead; he also received research grant from Alexion. N.D.P has served as an advisor or speaker for Moderna and AstraZeneca. Other authors have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Study flow chart. CAPA COVID-19-associated pulmonary aspergillosis; ICU intensive care unit
Fig. 2
Fig. 2
a Simon–Makuch estimates of overall survival status from ICU admission to day-90 according to CAPA status; b Simon–Makuch estimates of overall survival status from ICU admission to day-90 according to CAPA status using landmark times at 5 days
Fig. 3
Fig. 3
Unsupervised analysis of the clinical and biological characteristics of the 566 critically-ill COVID-19 patients by self-organized maps (SOMs). Unsupervised analysis by SOM automatically located patients with similar clinical and paraclinical parameters within 1 of 40 small groupings (“districts”) throughout the map. The more similar the patients, the closer on the map. Each individual map shows the mean values or proportions per district for each characteristic: blue indicates the lowest average values, red the highest, with numbers shown for a selection of representative districts in each SOM. For instance, immunosuppressed patients were more frequently located in the upper districts and also had higher serum urea levels, less frequent Delta variant infection, higher SAPS II and SOFA scores and day-28 mortality rates. WHO World Health Organization, SOFA Sequential Organ Failure Assessment, SAPS II Simplified Acute Physiology Score II, MV mechanical ventilation
See this image and copyright information in PMC

Comment in

References

    1. Gangneux JP, Dannaoui E, Fekkar A, Luyt CE, Botterel F, Prost ND, et al. Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study. Lancet Respir Med. 2021. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00442.... Accessed 9 Dec 2021. - PMC - PubMed
    1. Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R, Vanderbeke L, Van Tienen C, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 2018;6(10):782–792. doi: 10.1016/S2213-2600(18)30274-1. - DOI - PubMed
    1. Vanderbeke L, Janssen NAF, Bergmans DCJJ, Bourgeois M, Buil JB, Debaveye Y, et al. Posaconazole for prevention of invasive pulmonary aspergillosis in critically ill influenza patients (POSA-FLU): a randomised, open-label, proof-of-concept trial. Intensive Care Med. 2021;47(6):674–686. doi: 10.1007/s00134-021-06431-0. - DOI - PMC - PubMed
    1. Koehler P, Bassetti M, Chakrabarti A, Chen SCA, Colombo AL, Hoenigl M, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021;21(6):e149–e162. doi: 10.1016/S1473-3099(20)30847-1. - DOI - PMC - PubMed
    1. Vanderbeke L, Jacobs C, Feys S, Reséndiz-Sharpe A, Debaveye Y, Hermans G, et al. A pathology-based case series of influenza- and COVID-19-associated pulmonary aspergillosis: the proof is in the tissue. Am J Respir Crit Care Med. 2023 doi: 10.1164/rccm.202208-1570OC. - DOI - PMC - PubMed