Fungal infection common in critically ill COVID-19 patients
A retrospective study in Belgium found that risk of pulmonary aspergillosis in mechanically ventilated COVID-19 patients was primarily associated with pre-existing risk factors for invasive mold disease.
One-third of mechanically ventilated patients with COVID-19 developed COVID-19-associated pulmonary aspergillosis (CAPA), a recent study found.
Researchers performed a retrospective observational study using data from adult patients with COVID-19 who required mechanical ventilation and were admitted to the ICU of a tertiary referral and transplantation center in Belgium between March 1, 2020, and Nov. 14, 2022. Probable or proven CAPA was diagnosed on the basis of 2020 criteria developed by the European Confederation of Medical Mycology and the International Society for Human and Animal Mycology. The goal of the study was to determine whether rates of CAPA varied after COVID-19 vaccines became available and whether they were related to known host factors for invasive mold disease, as defined by the European Organisation for Research and Treatment of Cancer and Mycosis Study Group Education and Research Consortium. The results were published Sept. 11 by Clinical Infectious Diseases.
Three hundred thirty-five patients were included, and of these, 300 (90%) had bronchoalveolar lavage (BAL) sampling. One hundred twelve patients (33%) were diagnosed with CAPA. Those with CAPA were older than those without (mean age, 65 years vs. 62 years; P=0.0059) and were more likely to have host factors for invasive mold disease (45% vs. 14%; P<0.0001), including solid organ transplant, use of T- or B-cell immunosuppressants, and at-home use of low-dose corticosteroids. After COVID-19 vaccines became available, critically ill patients were more likely to have host factors for invasive mold disease (10% before October 2021 vs. 60% afterward) and rates of CAPA were also higher (24% vs. 59%, respectively). Ninety-day mortality rates after ICU admission were higher in patients with CAPA than in those without (48% vs. 21%).
The researchers noted that their study involved only one health care facility and that the criteria to diagnose probable aspergillosis in patients with severe COVID-19 have not been validated against histology, among other limitations. They concluded that presence of host factors for invasive mold disease is currently the main driver of higher CAPA incidence in critically ill COVID-19 patients and is associated with worse outcomes. “Our findings warrant setting up new prospective, international observational studies for CAPA in the vaccination era, and show the urgency for investigating antifungal prophylaxis in critically ill COVID-19 patients,” they wrote.
