Sivasubramanian Geetha, Ghanem Hebah, Maison-Fomotar Michele, Jain Ratnali, Libke Robert
Division of Infectious Diseases, Department of Internal Medicine, University of California, San Francisco, CA 93701, USA.
UCSF Fresno Research Institute, University of California, San Francisco, CA 93701, USA.
J Fungi (Basel). 2021 Nov 10;7(11):948. doi: 10.3390/jof7110948.
Reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have been widely published across the world since the onset of the pandemic with varying incidence rates. We retrospectively studied all patients with severe COVID-19 infection who were admitted to our tertiary care center's intensive care units between January 2020 and March 2021, who also had respiratory cultures positive for species. Among a large cohort of 970 patients admitted to the ICU with severe COVID-19 infections during our study period, 48 patients had species growing in respiratory cultures. Based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, 2 patients in the study had proven CAPA, 9 had probable CAPA, and 37 had possible CAPA. The incidence of CAPA was 5%. The mean duration from a positive COVID-19 test to spp. being recovered from the respiratory cultures was 16 days, and more than half of the patients had preceding fever or worsening respiratory failure despite adequate support and management. Antifungals were given for treatment in 44% of the patients for a mean duration of 13 days. The overall mortality rate in our study population was extremely high with death occurring in 40/48 patients (83%).
自新冠疫情爆发以来，关于2019冠状病毒病（COVID-19）相关肺曲霉病（CAPA）的报告在全球广泛发表，发病率各不相同。我们回顾性研究了2020年1月至2021年3月期间入住我们三级医疗中心重症监护病房的所有重症COVID-19感染患者，这些患者的呼吸道培养物中某种菌种呈阳性。在我们研究期间入住ICU的970例重症COVID-19感染患者的大样本队列中，48例患者的呼吸道培养物中有某种菌种生长。根据2020年欧洲医学真菌学联合会和国际人类与动物真菌学协会（ECMM/ISHAM）的共识标准，研究中有2例患者确诊为CAPA，9例可能为CAPA，37例可能为CAPA。CAPA的发病率为5%。从COVID-19检测呈阳性到呼吸道培养物中某种菌种被检出的平均时间为16天，超过一半的患者尽管得到了充分的支持和管理，但仍有先前的发热或呼吸衰竭恶化。44%的患者接受了抗真菌药物治疗，平均疗程为13天。我们研究人群的总体死亡率极高，48例患者中有40例死亡（83%）。
