Background Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. Methods We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. Findings CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. Interpretation CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.
【초록키워드】 COVID-19, Severe COVID-19 pneumonia, COVID-19 pneumonia, Risk factors, Mortality, Study protocol, mechanical ventilation, Pneumonia, diagnostic, outcome, risk factor, ICU, Laboratory, Viral pneumonia, Cohort, Viral, Critically ill, Patient, ICU admission, Complication, Logistic regression, age, incidence, severe viral pneumonia, early stage, critically ill patients, Clinical parameters, Combination, Analysis, Invasive pulmonary aspergillosis, matched controls, pulmonary aspergillosis, regression analysis, Critically ill patient, Virological, bronchial lavage, galactomannan, both groups, help, finding, Logistic regression analyses, high mortality rate, clinical parameter, COVID-19 cohort, APACHE II score, approach, controls, IPA, invasive, prevalent, defined, identify, affected, collected, evaluate, diagnosed, screened, median, not different, timepoint, 【제목키워드】 severe COVID-19, Critically ill patient, Result,