A National Strategy to Diagnose Coronavirus Disease 2019-Associated Invasive Fungal Disease in the Intensive Care Unit
A National Strategy to Diagnose Coronavirus Disease 2019-Associated Invasive Fungal Disease in the Intensive Care Unit
复制标题
DOI：
10.1093/cid/ciaa1298
复制
发表时间：
2021-10-01
影响因子：
11.8
通讯作者：
Backx, Matthijs
中科院分区：
文献类型：
--
作者：
White, P. Lewis;Dhillon, Rishi;Backx, Matthijs
背景真菌合并感染是呼吸道病毒感染的公认并发症，增加发病率和死亡率，但如果早期诊断，可以很容易地治疗。越来越多的小型研究报道了2019冠状病毒病（COVID-19）患者中的曲霉病，但缺乏全面的数据。本研究的目的是确定成人COVID-19严重呼吸窘迫患者中侵袭性真菌病的发病率、危险因素和影响。对一项全国性、多中心、前瞻性队列评估的评估，该评估旨在对诊断COVID-19重症监护患者侵袭性真菌病的增强检测策略进行评估。研究结果被用于产生一种机制来定义未来COVID-19患者的曲霉病。筛选了135名成人（中位年龄：57岁，男性/女性：2.2/1）。发病率为26.7%，其中曲霉菌感染14.1%，酵母菌感染12.6%。总死亡率为38%;有真菌病和无真菌病的患者分别为53%和31%（P = 0.0387）。使用抗真菌治疗降低了死亡率（死亡率：接受治疗的患者为38.5%，未接受治疗的患者为90%（P = 0.008））。皮质类固醇的使用（P = 0.007）和慢性呼吸系统疾病史（P = 0.05）增加了曲霉菌病的可能性。真菌病经常发生在重症机械通气的COVID-19患者中。在接受抗真菌治疗的患者中观察到的生存获益意味着所提出的诊断和定义标准是适当的。使用战略性诊断方法进行筛查，并对有风险因素的患者进行抗真菌预防，可能会加强对COVID-19患者的管理。
Background. Fungal coinfection is a recognized complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress are being reported, but comprehensive data are lacking. The aim of this study was to determine the incidence, risk factors, and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress.Methods. An evaluation of a national, multicenter, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients.Results. One-hundred and thirty-five adults (median age: 57, M/F: 2.2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12.6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P = .0387). The mortality rate was reduced by the use of antifungal therapy (mortality: 38.5% in patients receiving therapy vs 90% in patients not receiving therapy (P = .008). The use of corticosteroids (P = .007) and history of chronic respiratory disease (P = .05) increased the likelihood of aspergillosis.Conclusions. Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.