Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Frost, J.
Pulmonale Aspergillose in kritisch kranken COVID-19 PatientInnen auf der Intensivstation
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 82
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Prattes Jürgen
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- Abstract:
- Background: Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection that primarily affects individuals with immunodeficiencies. In addition to this main risk group, cases of IPA in the intensive care unit (ICU), especially in severe influenza, have also been reported. After the onset of the coronavirus disease 2019 (COVID-19)-pandemic, initial studies suggested a similar association between a severe course of COVID-19 and IPA as was observed with influenza. However, determining the frequency of COVID-19-associated pulmonary aspergillosis (CAPA) has been difficult because of the lack of standardized diagnostic criteria. Therefore, with this study, we aimed to determine the prevalence of CAPA in the ICU using the recently published consensus criteria. Furthermore, we sought to gain insight into the diagnostic value of biomarkers, such as galactomannan (GM), and risk factors associated with CAPA. Methods: Patients admitted to the ICU of the University Hospital Graz due to COVID-19-associated acute respiratory failure were enrolled in this study from March 2020 to May 2021. Relevant patient clinical data were extracted from the hospital's internal data information system and transferred into a pseudonymized electronic case report form. The decision to perform diagnostic procedures or therapy for the included patients was the sole responsibility of the treating physicians. Patients were classified as either CAPA (proven/probable/possible) or no evidence for CAPA based on the European Confederation for Medical Mycology and the International Society for Human and Animal Mycology diagnostic criteria. Descriptive analysis of variables and survival analysis with Kaplan-Meier estimators were performed. Results: Based on a total of 119 enrolled patients, eleven probable CAPA cases and one possible CAPA case were diagnosed. This results in a CAPA prevalence of 10.1% [95% confidence interval (CI) 5.9–14.3] in the entire cohort, whereas among invasively ventilated patients a CAPA prevalence of 20% (95% CI 12.7–29.1) was calculated. CAPA patients had a significantly longer ICU stay compared to those without evidence for CAPA. Patients were diagnosed with CAPA after a median of 7 days (25th–75th quartile: 3.5–12.75) after ICU admission. Bronchoalveolar lavage fluid (BALF) sampling was performed in every CAPA case. BALF GM turned out positive [GM>1.0 optical density index (ODI)] in 54.5% of CAPA cases with a median GM of 6.81 ODI (25th–75th quartile: 2.64–6.96). Serum GM turned out positive (GM>0.5 ODI) in 41.7% of CAPA cases. In all CAPA patients antifungal treatment was initiated. Survival of CAPA patients at 30 days after ICU admission, at ICU discharge and at the end of follow-up was 75%, 50% and 33.3%, respectively. Survival of non-CAPA patients at 30 days after ICU admission, at ICU discharge and at the end of follow-up was 60.7%, 57.9% and 53.3%, respectively. Conclusion: CAPA is a serious complication in invasively ventilated COVID-19 patients. To diagnose CAPA early, bronchoscopy is required in most cases to obtain respiratory samples. However, a substantial proportion of CAPA patients also have a positive serum GM result, reaching the angio-invasive stage of the disease, which is associated with poor survival rates. The diagnosis of the majority of CAPA cases could be made based on the detection of GM. Overall mortality in CAPA cases was not significantly higher than in patients without evidence of CAPA.