Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort.
Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort.
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DOI：
10.1016/j.cmi.2020.12.005
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发表时间：
2020-12-13
期刊：
影响因子：
--
通讯作者：
Alanio A
中科院分区：
文献类型：
--
作者：
Dellière S;Dudoignon E;Fodil S;Voicu S;Collet M;Oillic PA;Salmona M;Dépret F;Ghelfenstein-Ferreira T;Plaud B;Chousterman B;Bretagne S;Azoulay E;Mebazaa A;Megarbane B;Alanio A
本研究的主要目的是确定2019冠状病毒病（COVID-19）患者在重症监护室（ICU）中的侵袭性肺曲霉菌病（IPA）发生率，并描述与IPA发生相关的患者特征，并评估其对预后的影响。我们进行了一项回顾性队列研究，包括所有连续的COVID-19患者，在四个ICU住院，继发性恶化和一个或多个呼吸道样本被送往真菌科。我们使用了强化IPA测试策略，包括7个真菌学标准。如果免疫功能低下，则根据欧洲癌症研究和治疗组织（EORTC）/真菌病研究组教育和研究联盟（MSGERC）分类，将患者归类为可能的IPA，否则根据最近的COVID-19相关IPA分类。在366名入住ICU的COVID-19患者中，有21名（5.7%）被诊断为可能的IPA，108名（19.4%）因病情恶化接受呼吸道采样的患者被诊断为IPA。在年龄、性别、病史和入院时和住院期间的严重程度方面，在有和无IPA的患者之间没有观察到显著差异。阿奇霉素治疗≥ 3天与可能的IPA诊断相关（比值比3.1，95%置信区间1.1 - 8.5，p = 0.02）。观察到高剂量地塞米松和IPA发生的趋势。IPA患者的总死亡率较高（15/21，71.4% vs 32/87，36.8%，p <0.01）。IPA是严重COVID-19患者中相对常见的并发症，并导致死亡率增加。已知具有免疫调节特性的阿奇霉素可能有助于增加COVID-19患者对IPA的易感性。
The main objective of this study was to determine the incidence of invasive pulmonary aspergillosis (IPA) in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and to describe the patient characteristics associated with IPA occurrence and to evaluate its impact on prognosis. We conducted a retrospective cohort study including all successive COVID-19 patients, hospitalized in four ICUs, with secondary deterioration and one or more respiratory samples sent to the mycology department. We used a strengthened IPA testing strategy including seven mycological criteria. Patients were classified as probable IPA according to the European Organization for Research and Treatment of Cancer (EORTC)/Mycoses Study Group Education and Research Consortium (MSGERC) classification if immunocompromised, and according to the recent COVID-19-associated IPA classification otherwise. Probable IPA was diagnosed in 21 out of the 366 COVID-19 patients (5.7%) admitted to the ICU and in the 108 patients (19.4%) who underwent respiratory sampling for deterioration. No significant differences were observed between patients with and without IPA regarding age, gender, medical history and severity on admission and during hospitalization. Treatment with azithromycin for ≥3 days was associated with the diagnosis of probable IPA (odds ratio 3.1, 95% confidence interval 1.1–8.5, p = 0.02). A trend was observed with high-dose dexamethasone and the occurrence of IPA. Overall mortality was higher in the IPA patients (15/21, 71.4% versus 32/87, 36.8%, p < 0.01). IPA is a relatively frequent complication in severe COVID-19 patients and is responsible for increased mortality. Azithromycin, known to have immunomodulatory properties, may contribute to increase COVID-19 patient's susceptibility to IPA.
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