Little Jessica S, McGwin Gerald, Tushla Lisa, Benedict Kaitlin, Lyman Meghan M, Toda Mitsuru, Baddley John W, Pappas Peter G
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, PBB-A4, Boston, MA, 02115, USA.
Mycopathologia. 2025 Jan 21;190(1):16. doi: 10.1007/s11046-025-00928-8.
Invasive fungal disease (IFD) is a morbid superinfection that can arise in critically ill patients with COVID-19 infection. Studies evaluating the full spectrum of COVID-19-associated fungal infections remain limited.
Single-center retrospective study assessing IFD in patients with COVID-19, hospitalized for ≥ 72 h in the intensive care unit (ICU) between 02/25/20 and 02/28/22 (n = 1410). IFD was assessed using consensus criteria (EORTC/MSGERC or ISHAM/ECMM criteria). T- and chi-square tests compared demographic/clinical characteristics between IFD and non-IFD patients. Cox proportional hazards regression estimated risk factors for in-hospital mortality.
Of 1410 patients with severe COVID-19, 70 (5%) had a diagnosis of COVID-19-associated fungal infection with invasive candidiasis occurring in 3%, and invasive aspergillosis in 2%. Other fungal infections were rare. Patients with IFD had longer ICU stays (26 vs. 13 days; p < 0.001); increased rates of mechanical ventilation (99% vs. 70%; p < 0.001); and a higher risk of in-hospital death (69% vs. 36%; p < 0.001). On multivariable analysis, COVID-associated fungal infections were associated with an increased risk of in-hospital mortality.
This real-world study of critically ill patients with COVID-19 demonstrated a low incidence of COVID-19-associated fungal infections with invasive candidiasis occurring most frequently. Fungal infections were associated with an increased risk of in-hospital mortality in this population.
侵袭性真菌病（IFD）是一种严重的二重感染，可发生于新型冠状病毒肺炎（COVID-19）感染的重症患者中。评估COVID-19相关真菌感染全貌的研究仍然有限。
单中心回顾性研究，评估2020年2月25日至2022年2月28日期间在重症监护病房（ICU）住院≥72小时的COVID-19患者中的IFD（n = 1410）。使用共识标准（欧洲癌症研究与治疗组织/欧洲医学真菌学联合会或国际人类与动物真菌学会/欧洲临床微生物与传染病学会标准）评估IFD。采用t检验和卡方检验比较IFD患者与非IFD患者的人口统计学/临床特征。Cox比例风险回归估计院内死亡的危险因素。
在1410例重症COVID-19患者中，70例（5%）被诊断为COVID-19相关真菌感染，其中侵袭性念珠菌病占3%，侵袭性曲霉病占2%。其他真菌感染很少见。IFD患者的ICU住院时间更长（26天对13天；p < 0.001）；机械通气率更高（分别为99%和70%；p < 0.001）；院内死亡风险更高（分别为69%和36%；p < 0.001）。多变量分析显示，COVID相关真菌感染与院内死亡风险增加相关。
这项针对重症COVID-19患者的真实世界研究表明，COVID-19相关真菌感染的发生率较低，其中侵袭性念珠菌病最为常见。在该人群中，真菌感染与院内死亡风险增加相关。
