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 - Archive ouverte HAL Access content directly
Journal Articles Clinical Microbiology and Infection Year : 2022

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

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Juergen Prattes
Joost Wauters
Daniele Roberto Giacobbe
  • Function : Author
Jon Salmanton-García
Johan Maertens
Marc Bourgeois
  • Function : Author
Marijke Reynders
  • Function : Author
Lynn Rutsaert
  • Function : Author
Niels van Regenmortel
  • Function : Author
Piet Lormans
  • Function : Author
Simon Feys
  • Function : Author
Alexander Christian Reisinger
  • Function : Author
Oliver Cornely
Tobias Lahmer
  • Function : Author
Maricela Valerio
  • Function : Author
Laurence Delhaes
  • Function : Author
Kauser Jabeen
  • Function : Author
Joerg Steinmann
  • Function : Author
Mathilde Chamula
  • Function : Author
Matteo Bassetti
  • Function : Author
Stefan Hatzl
  • Function : Author
Riina Rautemaa-Richardson
  • Function : Author
Philipp Koehler
Katrien Lagrou
  • Function : Author
Martin Hoenigl
Yves Debaveye
  • Function : Author
Marisa Miceli
  • Function : Author
Gregor Paul
  • Function : Author
Robert Krause
  • Function : Author
Marina Linhofer
  • Function : Author
Jonas Frost
  • Function : Author
Peter Zechner
  • Function : Author
Matthias Kochanek
  • Function : Author
Philipp Eller
  • Function : Author
Jeffrey Jenks
  • Function : Author
Sara Volpi
  • Function : Author
P.Lewis White
  • Function : Author
Gustavo Goldman
Paul Bowyer
  • Function : Author
Antonis Rokas
  • Function : Author
Sara Gago
  • Function : Author
Paolo Pelosi
  • Function : Author
Chiara Robba
  • Function : Author
Jean-Pierre Gangneux
Cornelia Lass-Floerl
  • Function : Author
Marina Machado
Patricia Muñoz
  • Function : Author

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 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.

Dates and versions

hal-03528260 , version 1 (17-01-2022)

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Juergen Prattes, Joost Wauters, Daniele Roberto Giacobbe, Jon Salmanton-García, Johan Maertens, et al.. 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. Clinical Microbiology and Infection, 2022, 28 (4), pp.580-587. ⟨10.1016/j.cmi.2021.08.014⟩. ⟨hal-03528260⟩
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