Swaney Richard, Jokomo-Nyakabau Rutendo, Nguyen Anny A N, Kenny Dorothy, Millner Paul G, Selim Mohammad, Destache Christopher J, Velagapudi Manasa
Internal Medicine/Infectious Diseases, Creighton University School of Medicine, Omaha, NE 68178, USA.
Internal Medicine, Creighton University School of Medicine, Omaha, NE 68178, USA.
Microorganisms. 2023 Sep 15;11(9):2326. doi: 10.3390/microorganisms11092326.
The SARS-CoV-2 pandemic has resulted in a public health emergency with unique complications such as the development of fungal co-infections. The diagnosis of fungal infections can be challenging due to confounding imaging studies and difficulty obtaining histopathology. In this retrospective study, 173 patients with COVID-19 receiving antifungal therapy due to concern for fungal co-infection were evaluated. Patient characteristics, clinical outcomes, and the utility of fungal biomarkers were then evaluated for continuation of antifungal therapy. Data were collected from the electronic health record (EPIC) and analyzed using SPSS (version. 28, IBM, Inc., Armonk, NY, USA) Data are presented as mean ± SD or percentages. A total of 56 COVID-19 patients were diagnosed with fungal co-infection and 117 COVID-19 + patients had no fungal infection. Significantly fewer female patients were in the fungal+ group compared to COVID-19 control patients (29% in fungal+ compared to 51% in controls = 0.005). Fungal diagnostics were all significantly higher in fungal+ patients. These include 1,4-beta-D-glucan (BDG), fungal culture, and bronchoalveolar lavage galactomannan (BAL GM). Intensive care unit hospitalization, mechanical ventilation, and mortality in fungal+ patients with COVID-19 were significantly higher than in control patients. Finally, significantly more fungal+ patients received voriconazole, isavuconazonium, or amphotericin B therapies, whereas control patients received significantly more short-course fluconazole. COVID-19+ patients with fungal co-infection were significantly more likely to be in the ICU and mechanically ventilated, and they result in higher mortality compared to control COVID-19 patients. The use of fungal diagnostics markers were helpful for diagnosis.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行引发了一场公共卫生紧急事件，出现了诸如真菌合并感染等独特并发症。由于影像学研究结果相互矛盾以及获取组织病理学检查存在困难，真菌感染的诊断可能具有挑战性。在这项回顾性研究中，对173例因担心合并真菌感染而接受抗真菌治疗的新冠肺炎患者进行了评估。然后评估患者特征、临床结局以及真菌生物标志物在继续抗真菌治疗中的效用。数据从电子健康记录（EPIC）中收集，并使用SPSS（版本28，IBM公司，美国纽约州阿蒙克）进行分析。数据以均值±标准差或百分比表示。共有56例新冠肺炎患者被诊断为合并真菌感染，117例新冠肺炎阳性患者未发生真菌感染。与新冠肺炎对照患者相比，真菌阳性组的女性患者明显较少（真菌阳性组为29%，对照组为51%，P = 0.005）。真菌阳性患者的所有真菌诊断指标均显著更高。这些指标包括1,4-β-D-葡聚糖（BDG）、真菌培养和支气管肺泡灌洗半乳甘露聚糖（BAL GM）。新冠肺炎真菌阳性患者的重症监护病房住院率、机械通气率和死亡率显著高于对照患者。最后，显著更多的真菌阳性患者接受了伏立康唑、艾沙康唑或两性霉素B治疗，而对照患者接受短疗程氟康唑的比例显著更高。合并真菌感染的新冠肺炎阳性患者入住重症监护病房和接受机械通气的可能性显著更高，与新冠肺炎对照患者相比，死亡率也更高。真菌诊断标志物的使用有助于诊断。
