Paramythiotou Elisabeth, Dimopoulos George, Koliakos Nikolaos, Siopi Maria, Vourli Sophia, Pournaras Spyros, Meletiadis Joseph
2nd Department of Critical Care, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini str, Haidari 124 62, Athens, Greece.
Infect Dis Ther. 2021 Sep;10(3):1779-1792. doi: 10.1007/s40121-021-00486-8. Epub 2021 Jul 14.
Invasive pulmonary aspergillosis is an emerging complication among intensive care unit (ICU) patients with COVID-19 (CAPA). In the present study, all CAPA cases during the first year of the pandemic were reviewed in critically ill patients at a 650-bed tertiary Greek COVID-19 reference hospital.
Data regarding patients admitted to the ICU of Attikon Hospital in Athens, Greece, between 22 March 2020 and 28 February 2021 with a positive PCR for SARS-CoV-2 infection were reviewed. Clinical and microbiological records were analysed including demographic, clinical, laboratory and radiological features, treatment and outcomes. CAPA was determined according to the recent 2020 ECMM/ISHAM definitions.
A total of 179 patients were admitted in the ICU and 6 (3.3%) patients were diagnosed with CAPA (4 probable and 2 possible CAPA) with 5/6 with co-infection with multidrug-resistant (MDR) gram-negative pathogens. No patient had a history of immunosuppression. All suffered from acute respiratory distress syndrome. The median (range) time from intubation to diagnosis was 6 (1-14) days. Five patients had positive Aspergillus cultures in bronchial secretions (1 A. fumigatus, 1 A. flavus, 1 A. fumigatus + A. flavus, 1 A. fumigatus + A. terreus and 1 A. terreus) while culture was negative in one patient. All isolates were susceptible to antifungal drugs. Serum galactomannan (GM), pan-Aspergillus PCR and (1,3)-β-D-glucan (BDG) were positive in 4/6 (67%), 5/6 (83%, 3/5 in two consecutive samples) and 4/6 (67%, in consecutive samples) patients, respectively. GM and PCR positive bronchial secretions had GM indices > 9.95 and PCR C < 34. All were treated with antifungal drugs with 5 out of 6 receiving isavuconazole. Mortality was 67% (4/6) with 1/4 attributed to CAPA (two died as a result of bacterial septic shock and one as a result of multiorgan failure).
The incidence of CAPA in ICU patients was 3.3% and it was associated with approximately a 17% attributable mortality in the setting of MDR gram-negative pathogen co-infections.
侵袭性肺曲霉病是新型冠状病毒肺炎（COVID-19）重症监护病房（ICU）患者中出现的一种并发症（COVID-19相关侵袭性肺曲霉病，CAPA）。在本研究中，我们回顾了希腊一家拥有650张床位的三级COVID-19转诊医院在疫情第一年期间所有重症患者的CAPA病例。
回顾了2020年3月22日至2021年2月28日期间入住希腊雅典阿提卡医院ICU且严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染PCR检测呈阳性患者的数据。分析了临床和微生物学记录，包括人口统计学、临床、实验室和放射学特征、治疗及转归。CAPA根据2020年欧洲临床微生物与感染性疾病学会/国际人类与动物真菌病学会（ECMM/ISHAM）的最新定义确定。
共有179例患者入住ICU，6例（3.3%）患者被诊断为CAPA（4例可能病例和2例疑似病例），其中5/6合并多重耐药（MDR）革兰阴性病原体感染。所有患者均无免疫抑制病史。所有患者均患有急性呼吸窘迫综合征。从插管到诊断的中位（范围）时间为6（1 - 14）天。5例患者支气管分泌物曲霉培养阳性（1例烟曲霉、1例黄曲霉、1例烟曲霉 + 黄曲霉、1例烟曲霉 + 土曲霉和1例土曲霉），1例患者培养阴性。所有分离株均对抗真菌药物敏感。4/6（67%）、5/6（83%，连续两次样本检测中3/5）和4/6（67%，连续样本检测）的患者血清半乳甘露聚糖（GM）、泛曲霉PCR和（1,3）-β-D-葡聚糖（BDG）检测呈阳性。GM和PCR检测阳性的支气管分泌物中GM指数>9.95且PCR C<34。所有患者均接受了抗真菌药物治疗，6例中有5例接受了艾沙康唑治疗。死亡率为67%（4/6），其中1/4归因于CAPA（2例死于细菌性感染性休克，1例死于多器官功能衰竭）。
ICU患者中CAPA的发生率为3.3%，在合并MDR革兰阴性病原体感染的情况下，其归因死亡率约为17%。
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