Ebner Julia, Van den Nest Miriam, Bouvier-Azula Lukas, Füszl Astrid, Gabler Cornelia, Willinger Birgit, Diab-Elschahawi Magda, Presterl Elisabeth
Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Research Documentation and Analysis, IT4Science, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
J Fungi (Basel). 2022 Mar 8;8(3):273. doi: 10.3390/jof8030273.
Rates of invasive aspergillosis (IA) among COVID-19 ICU patients seem to reach over 30% in certain settings. At Vienna General Hospital (VGH), all rooms in COVID-19 ICUs were put under negative pressure as a protective measure, thus increasing the risk of exposure to environmental pathogens for patients. Even though all ICU patients are surveilled for healthcare-associated infections (HAI), there were concerns that the routine protocol might not be sufficient for IA detection. We reviewed the electronic patient charts of all patients with COVID-19 admitted to ICUs between 1 March 2020 and 31 July 2021 for fungal co- or superinfections, comparing four diagnostic algorithms based on different recommendations for the diagnosis of IA (according to EORTC/MSG, BM-AspICU, IAPA and CAPA) to our routine surveillance protocol. We found that out of 252 patients who were admitted to the ICU during the study period, 25 (9.9%) fulfilled the criteria of probable or possible IA of at least one algorithm. The IAPA definitions detected 25 and the CAPA definition 23 probable and 2 possible cases, out of which only 16 were classified as hospital-acquired IA by routine surveillance. In conclusion, adjustment of the routine protocol using a classification system especially designed for respiratory viral illness seems useful for the surveillance of IA in a highly vulnerable patient cohort.
在某些情况下，新冠重症监护病房（ICU）患者的侵袭性曲霉病（IA）发病率似乎超过30%。在维也纳总医院（VGH），作为一项保护措施，新冠ICU的所有病房都处于负压状态，因此增加了患者接触环境病原体的风险。尽管对所有ICU患者都进行了医疗相关感染（HAI）监测，但仍有人担心常规方案可能不足以检测IA。我们回顾了2020年3月1日至2021年7月31日期间入住ICU的所有新冠患者的电子病历，以查找真菌合并或重叠感染情况，并将基于不同IA诊断建议（根据欧洲癌症研究与治疗组织/侵袭性真菌感染协作组标准[EORTC/MSG]、血液学-侵袭性曲霉病重症监护病房标准[BM-AspICU]、侵袭性肺曲霉病亚太地区共识定义[IAPA]和重症监护病房获得性肺炎共识定义[CAPA]）的四种诊断算法与我们的常规监测方案进行了比较。我们发现，在研究期间入住ICU的252名患者中，有25名（9.9%）符合至少一种算法的可能或疑似IA标准。IAPA定义检测出25例可能病例，CAPA定义检测出23例可能病例和2例疑似病例，其中只有16例在常规监测中被归类为医院获得性IA。总之，使用专门为呼吸道病毒疾病设计的分类系统调整常规方案，似乎有助于对高危患者群体中的IA进行监测。
