Introduction

Invasive pulmonary aspergillosis is an emerging complication among intensive care unit (ICU) patients with COVID-19 (CAPA). In the present study, all CAPA cases during the first year of the pandemic were reviewed in critically ill patients at a 650-bed tertiary Greek COVID-19 reference hospital.

Methods

Data regarding patients admitted to the ICU of Attikon Hospital in Athens, Greece, between 22 March 2020 and 28 February 2021 with a positive PCR for SARS-CoV-2 infection were reviewed. Clinical and microbiological records were analysed including demographic, clinical, laboratory and radiological features, treatment and outcomes. CAPA was determined according to the recent 2020 ECMM/ISHAM definitions.

Results

A total of 179 patients were admitted in the ICU and 6 (3.3%) patients were diagnosed with CAPA (4 probable and 2 possible CAPA) with 5/6 with co-infection with multidrug-resistant (MDR) gram-negative pathogens. No patient had a history of immunosuppression. All suffered from acute respiratory distress syndrome. The median (range) time from intubation to diagnosis was 6 (1–14) days. Five patients had positive Aspergillus cultures in bronchial secretions (1 A. fumigatus, 1 A. flavus, 1 A. fumigatus + A. flavus, 1 A. fumigatus + A. terreus and 1 A. terreus) while culture was negative in one patient. All isolates were susceptible to antifungal drugs. Serum galactomannan (GM), pan-Aspergillus PCR and (1,3)-β-d-glucan (BDG) were positive in 4/6 (67%), 5/6 (83%, 3/5 in two consecutive samples) and 4/6 (67%, in consecutive samples) patients, respectively. GM and PCR positive bronchial secretions had GM indices > 9.95 and PCR C_t < 34. All were treated with antifungal drugs with 5 out of 6 receiving isavuconazole. Mortality was 67% (4/6) with 1/4 attributed to CAPA (two died as a result of bacterial septic shock and one as a result of multiorgan failure).

Conclusion

The incidence of CAPA in ICU patients was 3.3% and it was associated with approximately a 17% attributable mortality in the setting of MDR gram-negative pathogen co-infections.

中文翻译：

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希腊三级护理学术参考医院中 COVID-19 相关肺曲霉病 (CAPA) 的流行病学和发病率

介绍

侵袭性肺曲霉病是重症监护病房 (ICU) 的 COVID-19 (CAPA) 患者中出现的一种新并发症。在本研究中，大流行第一年的所有 CAPA 病例均在希腊一家拥有 650 个床位的三级 COVID-19 参考医院的重症患者中进行了审查。

方法

对 2020 年 3 月 22 日至 2021 年 2 月 28 日期间入住希腊雅典 Attikon 医院 ICU 且 SARS-CoV-2 感染 PCR 呈阳性的患者的数据进行了审查。分析了临床和微生物记录，包括人口统计、临床、实验室和放射学特征、治疗和结果。CAPA 是根据最新的 2020 ECMM/ISHAM 定义确定的。

结果

共有 179 名患者入住 ICU，其中 6 名（3.3%）患者被诊断为 CAPA（4 名疑似 CAPA，2 名可能 CAPA），其中 5/6 合并感染多重耐药（MDR）革兰氏阴性病原体。没有患者有免疫抑制史。所有人都患有急性呼吸窘迫综合征。从插管到诊断的中位（范围）时间为 6（1-14）天。5名患者的支气管分泌物中曲霉培养呈阳性（1例烟曲霉、1例黄曲霉、1例烟曲霉 + 黄曲霉、1例烟曲霉 + 土曲霉和1例土曲霉），而1例患者的培养结果为阴性。所有分离株均对抗真菌药物敏感。血清半乳甘露聚糖 (GM)、泛曲霉PCR 和 (1,3)-β- d-葡聚糖 (BDG) 在两个连续样本中分别为 4/6 (67%)、5/6 (83%、3/5) ）和 4/6（67%，连续样本）患者。GM 和 PCR 阳性支气管分泌物的 GM 指数 > 9.95，PCR C _t  < 34。所有患者均接受抗真菌药物治疗，其中 6 例中有 5 例接受艾沙康唑治疗。死亡率为 67% (4/6)，其中 1/4 归因于 CAPA（两人死于细菌感染性休克，一人死于多器官衰竭）。

结论

ICU 患者中 CAPA 的发生率为 3.3%，在耐多药革兰氏阴性病原体合并感染的情况下，CAPA 与大约 17% 的归因死亡率相关。