Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study
Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study
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新冠病毒感染插管患者中侵袭性肺曲霉病的流行病学：一项前瞻性研究
DOI：
10.1093/cid/ciaa1065
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发表时间：
2021-12-01
影响因子：
11.8
通讯作者：
Viale, Pierluigi
中科院分区：
文献类型：
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作者：
Bartoletti, Michele;Pascale, Renato;Viale, Pierluigi
背景我们评估了危重COVID-19插管患者中侵袭性肺曲霉菌病的发病率，并评估了侵袭性曲霉菌病的不同病例定义。在接受机械通气的经微生物证实的COVID-19成人患者中进行的前瞻性、多中心研究。所有纳入的参与者都接受了侵袭性肺曲霉病的筛查方案，在入院7天和临床恶化的情况下进行支气管肺泡灌洗半乳甘露聚糖和培养。根据之前的共识定义，病例被归类为冠状病毒相关肺曲霉病（CAPA）。并与侵袭性肺曲霉菌病（PIPA）进行比较。108例患者入组。30例（27.7%）患者在重症监护室（ICU）入院后中位4（2-8）天后诊断为可能的CAPA。Kaplan-Meier曲线显示，与不符合曲霉病标准的患者相比，CAPA（44% vs 19%，P = 0.002）或PIPA（74% vs 26%，P <0.001）患者的ICU入院30天死亡率显著较高。CAPA（OR，3.53; 95%CI，1.29-9.67; P = 0.014）或PIPA（OR，11.60; 95%CI，3.24-41.29; P <0.001）与ICU入院后30天死亡率之间的相关性得到证实，即使在用logistic回归模型校正混杂因素后也是如此。在接受伏立康唑治疗的CAPA患者中（13例; 43%），连续样本中死亡率降低（46% vs 59%; P = 0.30）和半乳甘露聚糖指数降低的趋势得到证实。我们发现在重症COVID-19患者中CAPA的发生率很高，它的发生似乎改变了疾病的自然病程。
Background. We evaluated the incidence of invasive pulmonary aspergillosis among intubated patients with critical COVID-19 and evaluated different case definitions of invasive aspergillosis.Methods. Prospective, multicenter study in adult patients with microbiologically confirmed COVID-19 receiving mechanical ventilation. All included participants underwent a screening protocol for invasive pulmonary aspergillosis with bronchoalveolar lavage galactomannan and cultures performed on admission at 7 days and in case of clinical deterioration. Cases were classified as coronavirus-associated pulmonary aspergillosis (CAPA) according to previous consensus definitions. The new definition was compared with putative invasive pulmonary aspergillosis (PIPA).Results. 108 patients were enrolled. Probable CAPA was diagnosed in 30 (27.7%) patients after a median of 4 (2-8) days from intensive care unit (ICU) admission. Kaplan-Meier curves showed a significantly higher 30-day mortality rate from ICU admission among patients with either CAPA (44% vs 19%, P = .002) or PIPA (74% vs 26%, P < .001) when compared with patients not fulfilling criteria for aspergillosis. The association between CAPA (OR, 3.53; 95% CI, 1.29-9.67; P = .014) or PIPA (OR, 11.60; 95% CI, 3.24-41.29; P < .001) with 30-day mortality from ICU admission was confirmed, even after adjustment for confounders with a logistic regression model. Among patients with CAPA receiving voriconazole treatment (13 patients; 43%) a trend toward lower mortality (46% vs 59%; P = .30) and reduction in galactomannan index in consecutive samples were observed.Conclusions. We found a high incidence of CAPA among critically ill COVID-19 patients and its occurrence seems to change the natural course of disease.