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
[저자] Juergen Prattes, Joost Wauters, Daniele Roberto Giacobbe, Jon Salmanton-García, Johan Maertens, Marc Bourgeois, Marijke Reynders, Lynn Rutsaert, Niels Van Regenmortel, Piet Lormans, Simon Feys, Alexander Christian Reisinger, Oliver A. Cornely, Tobias Lahmer, Maricela Valerio, Laurence Delhaes, Kauser Jabeen, Joerg Steinmann, Mathilde Chamula, Matteo Bassetti, Stefan Hatzl, Riina Rautemaa-Richardson, Philipp Koehler, Katrien Lagrou, Martin Hoenigl, the ECMM-CAPA Study GroupDebaveyeYves19MiceliMarisa H.20TudesqJean-Jacques21PaulGregor22KrauseRobert23LinhoferMarina23FrostJonas23ZechnerPeter24KochanekMatthias25EllerPhilipp26JenksJeffrey D.27VolpiSara28BellangerAnne-Pauline29WhiteP.Lewis30GoldmanGustavo H.31BowyerPaul32RokasAntonis33GagoSara32PelosiPaolo34RobbaChiara35GangneuxJean-Pierre36Lass-FloerlCornelia37MachadoMarina38MuñozPatricia38Surgical Intensive Care Unit, University Hospital Leuven, BelgiumUniversity of Michigan Hospitals, Ann Arbor, MI, USAMedical Intensive Care Unit, Saint-Louis Teaching Hospital, AP-HP, Université de Paris, Paris, FranceKlinik für Gastroenterologie, Pneumologie und Infektiologie, Katharinenhospital Stuttgart, Zentrum Innere Medizin, Klinikum Stuttgart, Stuttgart, GermanyMedical University of Graz, Graz, AustriaLKH Graz II Standort West, Graz, AustriaUniversity of Cologne, Medical Faculty and University Hospital Cologne, Department I of Internal Medicine, Excellence Centre for Medical Mycology (ECMM), Cologne, GermanyMedical Universtiy of Graz, Graz, AustriaUniversity of California San Diego, San Diego, CA, USAInfectious Disease Department of the Universitiy of Modena, Modena, ItalyLaboratoire de Parasitologie-Mycologie Pôle Biologie Anatomie Pathologique CHRU Jean Minjoz, Besançon, FrancePublic Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, UKFaculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, BrazilThe University of Manchester, Manchester, UKDepartment of Biological Sciences, Vanderbilt University, Nashville, TN, USADepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, ItalyA.O.U. San Martino - IST, Istituto Nazionale Ricerca sul Cancro, Genoa, ItalyMycology-Parasitology Laboratory, Rennes Teaching Hospital, Rennes, FranceInnsbruck Medical University, AustriaClinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain†
, Yves Debaveye, Marisa H. Miceli, Jean-Jacques Tudesq, Gregor Paul, Robert Krause, Marina Linhofer, Jonas Frost, Peter Zechner, Matthias Kochanek, Philipp Eller, Jeffrey D. Jenks, Sara Volpi, Anne-Pauline Bellanger, P.Lewis White, Gustavo H. Goldman, Paul Bowyer, Antonis Rokas, Sara Gago, Paolo Pelosi, Chiara Robba, Jean-Pierre Gangneux, Cornelia Lass-Floerl, Marina Machado, Patricia Muñoz
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 centres from nine 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%) 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 days) 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 centre 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 centres. 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.