Clin Microbiol Infect . Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients- a multinational observational study by the European Confederation of Medical Mycology

[tetano]

lin Microbiol Infect


. 2021 Aug 25;S1198-743X(21)00474-2.
doi: 10.1016/j.cmi.2021.08.014. Online ahead of print.
Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients- a multinational observational study by the European Confederation of Medical Mycology


Juergen Prattes ¹ , Joost Wauters ² , Daniele Roberto Giacobbe ³ , Jon Salmanton-García ⁴ , Johan Maertens ⁵ , Marc Bourgeois ⁶ , Marijke Reynders ⁶ , Lynn Rutsaert ⁷ , Niels Van Regenmortel ⁷ , Piet Lormans ⁸ , Simon Feys ⁸ , Alexander Christian Reisinger ⁹ , Oliver A Cornely ⁴ , Tobias Lahmer ¹⁰ , Maricela Valerio ¹¹ , Laurence Delhaes ¹² , Kauser Jabeen ¹³ , Joerg Steinmann ¹⁴ , Mathilde Chamula ¹⁵ , Matteo Bassetti ³ , Stefan Hatzl ⁹ , Riina Rautemaa-Richardson ¹⁵ , Philipp Koehler ¹⁶ , Katrien Lagrou ⁵ , Martin Hoenigl ¹⁷ , ECMM-CAPA Study Group*



Collaborators, Affiliations

• PMID: 34454093
• DOI: 10.1016/j.cmi.2021.08.014

Abstract

Objectives: Coronavirus disease 2019 (COVID-19) associated pulmonary aspergillosis (CAPA) has emerged as a complication in critically ill COVID-19 patients. The objectives of this multinational study were to determine the prevalence of CAPA in patients with COVID-19 in intensive care units (ICU) and to investigate risk factors for CAPA as well as outcome.
Methods: The European Confederation of Medical Mycology (ECMM) conducted a multinational study including 20 centers from nine different countries to assess epidemiology, risk factors, and outcome of CAPA. CAPA was defined according to the 2020 ECMM/ISHAM consensus definitions.
Results: A total of 592 patients were included in this study, including 11 (1.9%) patients with histologically proven CAPA, 80 (13.5%) patients with probable CAPA, 18 (3%) with possible CAPA and 483 (81.6%) without CAPA. CAPA was diagnosed a median of 8 days (range 0-31) after ICU admission predominantly in older patients [adjusted hazard ratio (aHR) 1.04 per year; 95%CI 1.02-1.06] with any form of invasive respiratory support (HR 3.4; 95%CI 1.84-6.25) and receiving tocilizumab (HR 2.45; 95%CI 1.41-4.25). Median prevalence of CAPA per center was 10.7% (range 1.7%-26.8%). CAPA was associated with significantly lower 90-day ICU survival rate (29% in patients with CAPA versus 57% in patients without CAPA; Mantel-Byar p<0.001) and remained an independent negative prognostic variable after adjusting for other predictors of survival (HR=2.14; 95%CI: 1.59-2.87, p<=0.001).
Conclusion: Prevalence of CAPA varied between centers. CAPA was significantly more prevalent among older patients, patients receiving invasive ventilation and patients receiving tocilizumab, and was an independent strong predictor of ICU mortality.