Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave
Background: Critically ill COVID-19 patients have proven to be at risk for developing invasive fungal infections. However, the incidence and impact of possible/probable COVID-19-associated pulmonary aspergillosis (CAPA) in severe COVID-19 patients varies between cohorts. We aimed to assess the incid...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-01-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/8/2/96 |
| _version_ | 1797478932675559424 |
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| author | Robbert G. Bentvelsen Andreas L. E. Van Arkel Tom A. Rijpstra Merijn K. M. Kant Simone Van Der Sar-Van Der Brugge Daan W. Loth Peter Van Wijngaarden Arthur W. F. Du Mée David C. Y. Yick Bram M. W. Diederen Peter C. Wever Alexander C. A. P. Leenders Laura Van Dommelen Klaas H. De Groot Wouter Van den Bijllaardt Paul E. Verweij |
| author_facet | Robbert G. Bentvelsen Andreas L. E. Van Arkel Tom A. Rijpstra Merijn K. M. Kant Simone Van Der Sar-Van Der Brugge Daan W. Loth Peter Van Wijngaarden Arthur W. F. Du Mée David C. Y. Yick Bram M. W. Diederen Peter C. Wever Alexander C. A. P. Leenders Laura Van Dommelen Klaas H. De Groot Wouter Van den Bijllaardt Paul E. Verweij |
| author_sort | Robbert G. Bentvelsen |
| collection | DOAJ |
| description | Background: Critically ill COVID-19 patients have proven to be at risk for developing invasive fungal infections. However, the incidence and impact of possible/probable COVID-19-associated pulmonary aspergillosis (CAPA) in severe COVID-19 patients varies between cohorts. We aimed to assess the incidence, risk factors, and clinical outcome of invasive pulmonary aspergillosis in a regional cohort of COVID-19 intensive care patients. Methods: We performed a regional, multicentre, retrospective cohort study in the intensive care units (ICUs) in North Brabant, The Netherlands. We included adult patients with rt-PCR-confirmed SARS-CoV-2 infection (COVID-19), requiring mechanical ventilation for acute respiratory distress syndrome. Demographics, clinical course, biomarker value, and treatment outcomes were compared between the groups with possible/probable CAPA from the main study centre and the regional centres, and without signs of CAPA from the main study centre as controls. The primary aim was to assess the regional impact of possible/probable CAPA in COVID-19 ICU patients, measured as all-cause mortality at 30 days after ICU admission. Secondary outcomes were risk factors for developing CAPA, based on underlying host factors and to identify the value of the mycological arguments for the diagnosing of CAPA. Results: Between 1 March and 30 April 2020, we included 123 patients with severe COVID-19: 29 patients (30.9%) in the main ICU with possible/probable CAPA, and 65 (69.1%) with no signs of CAPA; 29 patients in the regional ICUs with signs of CAPA. Patients’ characteristics and risk factors did not differ for CAPA and non-CAPA patients. Patients with COPD and/or chronic steroid medication developed CAPA more frequently, although this was not statistically significant. CAPA patients were admitted to the ICU earlier, had lower PF-ratios, and more often required renal replacement therapy. All-cause 30-day mortality was significantly higher in mechanically ventilated COVID-19 patients with possible/probable CAPA 39.7% (23/58) compared to patients without evidence for CAPA 16.9% (11/65) (OR 3.2 [95% CI 1.4–7.4] <i>p</i> = 0.005). Conclusion: The high incidence of possible and probable CAPA in critically ill COVID-19 patients is alarming. The increase in 30-day mortality in CAPA highlights the need for active surveillance and management strategies in critically ill COVID-19 patients. |
| first_indexed | 2024-03-09T21:39:38Z |
| format | Article |
| id | doaj.art-d8ac47268e3240b3941b38e1042b6792 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-09T21:39:38Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-d8ac47268e3240b3941b38e1042b67922023-11-23T20:36:49ZengMDPI AGJournal of Fungi2309-608X2022-01-01829610.3390/jof8020096Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First WaveRobbert G. Bentvelsen0Andreas L. E. Van Arkel1Tom A. Rijpstra2Merijn K. M. Kant3Simone Van Der Sar-Van Der Brugge4Daan W. Loth5Peter Van Wijngaarden6Arthur W. F. Du Mée7David C. Y. Yick8Bram M. W. Diederen9Peter C. Wever10Alexander C. A. P. Leenders11Laura Van Dommelen12Klaas H. De Groot13Wouter Van den Bijllaardt14Paul E. Verweij15Microvida Laboratory for Microbiology, Amphia Hospital, 4818 CK Breda, The NetherlandsMicrovida Laboratory for Microbiology, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Intensive Care Medicine, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Intensive Care Medicine, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Pulmonary Medicine, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Pulmonary Medicine, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Internal Medicine, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Radiology, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Pathology, Amphia Hospital, 4818 CK Breda, The NetherlandsMicrovida Laboratory for Microbiology, Bravis Hospital, 4704 RA Roosendaal, The NetherlandsDepartment of Medical Microbiology, Bernhoven Hospital, 5406 PT Uden, The NetherlandsDepartment of Medical Microbiology and Infection Control, Jeroen Bosch Hospital, 5223 GZ Hertogenbosch, The NetherlandsDepartment of Medical Microbiology, Stichting PAMM, 5500 AA Veldhoven, The NetherlandsDepartment of Intensive Care, Máxima Medical Center, 5631 BM Veldhoven, The NetherlandsMicrovida Laboratory for Microbiology, Amphia Hospital, 4818 CK Breda, The NetherlandsDepartment of Medical Microbiology, Radboud University Medical Center, 6500 HB Nijmegen, The NetherlandsBackground: Critically ill COVID-19 patients have proven to be at risk for developing invasive fungal infections. However, the incidence and impact of possible/probable COVID-19-associated pulmonary aspergillosis (CAPA) in severe COVID-19 patients varies between cohorts. We aimed to assess the incidence, risk factors, and clinical outcome of invasive pulmonary aspergillosis in a regional cohort of COVID-19 intensive care patients. Methods: We performed a regional, multicentre, retrospective cohort study in the intensive care units (ICUs) in North Brabant, The Netherlands. We included adult patients with rt-PCR-confirmed SARS-CoV-2 infection (COVID-19), requiring mechanical ventilation for acute respiratory distress syndrome. Demographics, clinical course, biomarker value, and treatment outcomes were compared between the groups with possible/probable CAPA from the main study centre and the regional centres, and without signs of CAPA from the main study centre as controls. The primary aim was to assess the regional impact of possible/probable CAPA in COVID-19 ICU patients, measured as all-cause mortality at 30 days after ICU admission. Secondary outcomes were risk factors for developing CAPA, based on underlying host factors and to identify the value of the mycological arguments for the diagnosing of CAPA. Results: Between 1 March and 30 April 2020, we included 123 patients with severe COVID-19: 29 patients (30.9%) in the main ICU with possible/probable CAPA, and 65 (69.1%) with no signs of CAPA; 29 patients in the regional ICUs with signs of CAPA. Patients’ characteristics and risk factors did not differ for CAPA and non-CAPA patients. Patients with COPD and/or chronic steroid medication developed CAPA more frequently, although this was not statistically significant. CAPA patients were admitted to the ICU earlier, had lower PF-ratios, and more often required renal replacement therapy. All-cause 30-day mortality was significantly higher in mechanically ventilated COVID-19 patients with possible/probable CAPA 39.7% (23/58) compared to patients without evidence for CAPA 16.9% (11/65) (OR 3.2 [95% CI 1.4–7.4] <i>p</i> = 0.005). Conclusion: The high incidence of possible and probable CAPA in critically ill COVID-19 patients is alarming. The increase in 30-day mortality in CAPA highlights the need for active surveillance and management strategies in critically ill COVID-19 patients.https://www.mdpi.com/2309-608X/8/2/96COVID-19pulmonary aspergillosisCAPAcorticosteroidsvoriconazole |
| spellingShingle | Robbert G. Bentvelsen Andreas L. E. Van Arkel Tom A. Rijpstra Merijn K. M. Kant Simone Van Der Sar-Van Der Brugge Daan W. Loth Peter Van Wijngaarden Arthur W. F. Du Mée David C. Y. Yick Bram M. W. Diederen Peter C. Wever Alexander C. A. P. Leenders Laura Van Dommelen Klaas H. De Groot Wouter Van den Bijllaardt Paul E. Verweij Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave Journal of Fungi COVID-19 pulmonary aspergillosis CAPA corticosteroids voriconazole |
| title | Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave |
| title_full | Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave |
| title_fullStr | Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave |
| title_full_unstemmed | Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave |
| title_short | Regional Impact of COVID-19-Associated Pulmonary Aspergillosis (CAPA) during the First Wave |
| title_sort | regional impact of covid 19 associated pulmonary aspergillosis capa during the first wave |
| topic | COVID-19 pulmonary aspergillosis CAPA corticosteroids voriconazole |
| url | https://www.mdpi.com/2309-608X/8/2/96 |
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