COVID-19 患者真菌感染的抗真菌治疗：系统评价和荟萃分析。

Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis.

机构信息

Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.

Department of Pharmacy Practice, TVM College of Pharmacy, Rajiv Gandhi University of Health Sciences, Ballari, Karnataka, India.

出版信息

PLoS One. 2022 Jul 28;17(7):e0271795. doi: 10.1371/journal.pone.0271795. eCollection 2022.

DOI:10.1371/journal.pone.0271795

PMID:35901069

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9333218/

Abstract

OBJECTIVES

The prevalence of fungal secondary infections among COVID-19 patients and efficacy of antifungal therapy used in such patients is still unknown. Hence, we conducted this study to find the prevalence of fungal secondary infections among COVID-19 patients and patient outcomes in terms of recovery or all-cause mortality following antifungal therapy (AFT) in such patients.

METHODS

We performed a comprehensive literature search in PubMed®, Scopus®, Web of Sciences™, The Cochrane Library, ClinicalTrial.gov, MedRxiv.org, bioRxiv.org, and Google scholar to identify the literature that used antifungal therapy for the management fungal secondary infections in COVID-19 patients. We included case reports, case series, prospective & retrospective studies, and clinical trials. Mantel Haenszel random-effect model was used for estimating pooled risk ratio for required outcomes.

RESULTS

A total of 33 case reports, 3 case series, and 21 cohort studies were selected for final data extraction and analysis. The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. Azoles were the most commonly (65.1%) prescribed AFT. Study shows that high survival frequency among patients using AFT, received combination AFT and AFT used for >28 days. The meta-analysis showed, no significant difference in all-cause mortality between patients who received AFT and without AFT (p = 0.17), between types of AFT (p = 0.85) and the duration of AFT (p = 0.67).

CONCLUSION

The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. The survival frequency was high among patients who used AFT for fungal secondary infections, received combination AFT and AFT used for >28 days. However, meta-analysis results found that all-cause mortality in COVID-19 patients with fungal secondary infections is not significantly associated with type and duration of AFT, mostly due to presence of confounding factors such as small number of events, delay in diagnosis of fungal secondary infections, presence of other co-infections and multiple comorbidities.

摘要

目的

新冠病毒（COVID-19）患者中真菌继发感染的流行情况以及抗真菌治疗（AFT）的疗效尚不清楚。因此，我们开展了这项研究，以确定 COVID-19 患者中真菌继发感染的流行情况，以及在 COVID-19 患者中使用 AFT 治疗后患者在康复或全因死亡率方面的结局。

方法

我们在 PubMed®、Scopus®、Web of SciencesTM、The Cochrane Library、ClinicalTrials.gov、MedRxiv.org、bioRxiv.org 和 Google Scholar 中进行了全面的文献检索，以确定使用 AFT 治疗 COVID-19 患者中真菌继发感染的文献。我们纳入了病例报告、病例系列、前瞻性和回顾性研究以及临床试验。采用 Mantel Haenszel 随机效应模型估计所需结局的汇总风险比。

结果

共纳入 33 篇病例报告、3 篇病例系列和 21 篇队列研究进行最终的数据提取和分析。COVID-19 患者中真菌继发感染的流行率为 28.2%。唑类药物是最常（65.1%）处方的 AFT。研究表明，使用 AFT 的患者生存率较高，接受联合 AFT 治疗和 AFT 治疗时间>28 天的患者生存率更高。荟萃分析显示，使用 AFT 和未使用 AFT 的患者全因死亡率无显著差异（p=0.17），AFT 类型（p=0.85）和 AFT 持续时间（p=0.67）之间也无显著差异。

结论

COVID-19 患者中真菌继发感染的流行率为 28.2%。使用 AFT 治疗真菌继发感染、接受联合 AFT 治疗和 AFT 治疗时间>28 天的患者生存率较高。然而，荟萃分析结果发现，COVID-19 患者中真菌继发感染的全因死亡率与 AFT 的类型和持续时间无显著相关性，这主要是由于存在混杂因素，如事件数量较少、真菌继发感染的诊断延迟、存在其他合并感染和多种合并症。