Invasive aspergillosis in patients with COVID-19 in intensive care units: results of a multicenter study

Clinical Microbiology and Antimicrobial Chemotherapy. 2022; 24(4):295-302

​ Shadrivova O.V., Rachina S.A., Strelkova D.A., Panchishina K.A., Gusev D.A., Vashukova M.A., Meshchaninova S.G., Zavrazhnov A.A., Mitichkin M.S., Mamonov A.G., Khostelidi S.N., Kozlova O.P., Gusarov V. G., Zamyatin M.N., Lovtsevich N.V., Kuleshov V.G., shagdileeva-ev., Oganesyan E., Desyatik E.A., Borzova Yu.V., Ignatyeva S.M., Vasilieva N.V., Klimko N.N.
10.36488/cmac.2022.4.295-302
invasive aspergillosis Aspergillus spp COVID-19 ICU
Section
Diseases and Pathogens
Type
Original Article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2022; 24(4):295-302

Objective.

To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU).

Materials and Methods.

A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male – 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male – 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male – 67%.

Results.

64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104–11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177–18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01).

Conclusions.

IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.

Olga V. Shadrivova

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Svetlana A. Rachina

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Daria А. Strelkova

I.M. Sechenov First Moscow State Medical University, Moscow, Russia

Panchishina K.A.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Gusev D.A.

Clinical Infectious Diseases Hospital named after S.P. Botkin, Saint-Petersburg, Russia

Vashukova M.A.

Clinical Infectious Diseases Hospital named after S.P. Botkin, Saint-Petersburg, Russia

Meshchaninova S.G.

Clinical Infectious Diseases Hospital named after S.P. Botkin, Saint-Petersburg, Russia

Zavrazhnov A.A.

City Mariinskaya Hospital, Saint-Petersburg, Russia

Mitichkin M.S.

City Mariinskaya Hospital, Saint-Petersburg, Russia

Mamonov A.G.

City Mariinskaya Hospital, Saint-Petersburg, Russia

Sofya N. Khostelidi

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Kozlova O.P.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Vitaly G. Gusarov

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Zamyatin M.N.

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Lovtsevich N.V.

National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia

Kuleshov V.G.

City Clinical Hospital named after S.S. Yudin, Moscow, Russia

shagdileeva-ev.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Oganesyan E.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Desyatik E.A.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Borzova Yu.V.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Ignatyeva S.M.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Vasilieva N.V.

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

Nikolay N. Klimko

North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russia

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