Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
PLoS One. 2021 Mar 17;16(3):e0238825. doi: 10.1371/journal.pone.0238825. eCollection 2021.
Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia.
We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls.
CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA.
CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.
包括侵袭性肺曲霉病（IPA）在内的合并感染是重症危重症患者严重病毒性肺炎的常见并发症。本研究旨在评估重症 COVID-19 肺炎患者 IPA 的发生率、危险因素和结局。
我们使用标准化研究方案，前瞻性筛选了 32 例重症 COVID-19 肺炎患者，对 COVID-19 相关侵袭性肺曲霉病（CAPA）的发生进行为期 28 天的观察。我们在规定的时间点收集了实验室、微生物学、病毒学和临床参数，并结合非定向支气管灌洗（NBL）进行半乳甘露聚糖抗原检测。我们使用逻辑回归分析来评估 COVID-19 是否与 IPA 独立相关，并与匹配的对照组进行比较。
与对照组的 8%相比，在 32 例重症 COVID-19 肺炎患者中，11 例（34%）患者在 ICU 入院后中位数 4 天被诊断为 CAPA。在 COVID-19 组中，CAPA 患者的平均年龄、APACHE II 评分和 ICU 死亡率均高于无 CAPA 患者（36%对 9.5%；p<0.001）。两组患者的 ICU 住院时间（21 天与 17 天；p=0.340）和机械通气时间（20 天与 15 天；p=0.570）无差异。在回归分析中，COVID-19 和 APACHE II 评分与 IPA 独立相关。
CAPA 发生率高，死亡率高。COVID-19 与 IPA 独立相关。本研究提出的标准化筛查和诊断方法有助于早期识别受影响的患者。
