scholarly journals 279. Clinical Characteristics of Critically Ill Patients with COVID-19 and Invasive Pulmonary Aspergillosis: A Case Series From Mexico City

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S245-S245
Author(s):  
Patricia Galindo-Lopez ◽  
Benjamin Valente-Acosta ◽  
Francisco Moreno-Sanchez ◽  
Luis Espinosa-Aguilar ◽  
Irma Hoyo-Ulloa ◽  
...  
Keyword(s):  
Critically Ill ◽  
Mexico City ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Invasive Mechanical Ventilation ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Global Public Health ◽  
Pulmonary Aspergillosis ◽  
The Mean

Abstract Background COVID-19 has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in case series of critically ill patients. However, the criteria for CAPA diagnosis has been inconsistent among most of the reports. Mexico has been widely affected by SARS-CoV-2. We present a series of CAPA cases at a teaching hospital in Mexico City. Methods We performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from May 1st, 2020, to May 1st, 2021. Including only those with critical COVID-19 who required invasive mechanical ventilation (IMV). Patients with a diagnosis of CAPA were analyzed. We followed the 2020 ECMM/ISHAM consensus criteria for CAPA diagnosis. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika). Results Among the 230 admitted patients who required IMV, we identified 49 (21.3%) cases of CAPA, 46 probable CAPA and 3 proven CAPA. Nineteen (38%) of those died in the hospital. The mean age was 64.5 ± 12.6 years and 11 were female. Proven CAPA was diagnosed with culture in three cases (one A. niger, one A. terreus and one A. fumigatus). Probable CAPA was diagnosed by a positive serum GP in 27 (55.1%) patients and by a positive bronchoalveolar lavage (BAL) GP in 29 (59.2%) cases. Seven patients had both serum and BAL positive GP. Forty-six (93.9%) patients received corticosteroids, and 22 (49.9%) were treated with tocilizumab before CAPA diagnosis. All but one received isavuconazole as CAPA treatment. We detected 35 (71.4%) patients who had a bacterial co-infection. Eighteen of those died (51.4%) compared to only one dead in the subgroup without coinfections (7.1%). The mean time from hospital admission to CAPA diagnosis was 6.2 days (SD 7.1) among those who survived compared to 13.2 (SD 6.3) days in those who died p< 0.01. Conclusion CAPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality when it occurs with other bacterial coinfections and when it is diagnosed late from admission. Disclosures All Authors: No reported disclosures

scholarly journals 356. Clinical characteristics of critically ill patients with COVID-19 and invasive pulmonary aspergillosis: a case series from Mexico City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S247-S248
Author(s):  
Benjamin VALENTE-ACOSTA ◽  
Francisco Moreno-Sanchez ◽  
Luis Espinosa-Aguilar ◽  
Irma Hoyo-Ulloa ◽  
Raquel Mendoza-Aguilar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Aspergillus Niger ◽  
Critically Ill ◽  
Mexico City ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Tracheal Aspirate ◽  
Pulmonary Aspergillosis

Abstract Background COVID-19, caused by SARS-CoV-2, has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. Invasive pulmonary aspergillosis (IPA) superinfection has been reported in case series of critically ill patients. Mexico has been widely affected by SARS-CoV-2. We present a case series of COVID-19-associated IPA at a teaching hospital in Mexico City. Methods We performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from March 13 to June 1, 2020. Only those with severe or critical COVID-19 were hospitalized. Patients with a diagnosis of putative IPA were analyzed. SARS-CoV-2 was diagnosed by Real-Time PCR from nasopharyngeal swabs. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika).The study was approved by the hospital ethics committee. Results Among the 47 admitted patients who required invasive mechanical ventilation (IMV), we identified seven (14.9%) cases of IPA. The mean age was 59.7 ± 17.8 years and five were male. All our patients had comorbidities, but none were under previous immunosuppressive treatment. All had critical COVID-19 pneumonia requiring IMV. All but one patient received corticosteroids, and five patients were treated with tocilizumab before IPA diagnosis. Putative IPA was diagnosed in six cases (86%) by a positive GP in tracheal aspirate, additionally in one of these, the tracheal aspirate culture also grew Aspergillus niger. The remaining one (14%) had a positive serum GP. The median time from COVID-19 to IPA diagnosis was 10 days. There were five bacterial co-infections, three with Pseudomonas aeruginosa, one with Stenotrophomonas maltophilia, and one with Mycobacterium tuberculosis. Six patients were treated with isavuconazole and one voriconazole. As of June 17, 2020, three patients had died, two patients had been discharged, and two were still in the intensive care unit receiving IMV. Aspergillus niger isolated from a tracheal aspirate of a critically-ill COVID-19 patient Conclusion COVID-19-associated IPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality and could be associated with other bacterial coinfections. Disclosures All Authors: No reported disclosures

scholarly journals 1175. Pulmonary Aspergillosis in Critically Ill Patients with COVID-19: A Case Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S613-S613
Author(s):  
Hayato Mitaka ◽  
David C Perlman ◽  
Waleed Javaid ◽  
Nadim Salomon
Keyword(s):  
Aspergillus Fumigatus ◽  
Critically Ill ◽  
Antifungal Therapy ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Tracheal Aspirate ◽  
High Dose ◽  
Clinical Predictors ◽  
Pulmonary Aspergillosis

Abstract Background Invasive pulmonary aspergillosis (IPA) has been reported in critically ill patients without pre-existing immunocompromising conditions. However, there are scant data on pulmonary aspergillosis in patients with COVID-19. Methods We performed a retrospective review of pharmacy records of antifungal use during 3/21-4/22, 2020, and collect longitudinal clinical data. Cases were then classified by the clinical algorithm for IPA in the ICU (AspICU). Results 7 out of 18 (39%) patients who received antifungal therapy had Aspergillus fumigatus in tracheal aspirate specimens while mechanically ventilated in the ICU. None of the patients had EORTC/MSG host factors. Median time from admission to the date of positive respiratory culture was 9 days (range: 2-15). High-dose glucocorticoids were started a mean of 5.6 days (range 3-8) before the positive respiratory culture in 5 and on the day of the culture in 2. Six received 583-1000 mg equivalent of prednisone. Two received Tocilizumab. By AspICU criteria, 4 had putative IPA. Radiographic abnormalities included cavitary pneumonia, opacities with dense consolidation, worsening infiltrates, and diffuse interstitial and patchy hazy opacities. Compatible signs included worsening respiratory failure in 3 and fever after 3 days of antibacterial agents in 1. Associated findings were leukocytosis in 4, > 1 positive cultures in 3, high procalcitonin in 2, and positive serum galactomannan in 1. The remaining three were classified as colonization as they lacked compatible signs. One had concomitant Klebsiella aerogenes pneumonia with bacteremia, and two later developed Candidemia and Stenotrophomonas maltophilia pneumonia, respectively. All 3 had fever with leukocytosis. One had elevated procalcitonin. Six received antifungal therapy; one did not due to goals of care. All 7 patients expired despite ICU care. Conclusion The critically ill patients with severe COVID-19 in whom respiratory culture grew Aspergillus fumigatus showed very high mortality despite antifungal treatment. By AspICU algorithm, 4 patients had putative IPA. Further data on risk factors and clinical predictors of IPA in COVID-19 are needed. Disclosures All Authors: No reported disclosures

scholarly journals Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19

2020 ◽  
Vol 8 (6) ◽  
pp. e48-e49 ◽  
Author(s):  
Alexandre Alanio ◽  
Sarah Dellière ◽  
Sofiane Fodil ◽  
Stéphane Bretagne ◽  
Bruno Mégarbane
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Clinical Course and Outcomes of Severe Covid-19: A National Scale Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2282 ◽  
Author(s):  
Moran Amit ◽  
Alex Sorkin ◽  
Jacob Chen ◽  
Barak Cohen ◽  
Dana Karol ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Infection ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Case Series ◽  
Government Officials ◽  
Multivariable Regression Model ◽  
Multivariable Regression ◽  
Overall Mortality

Knowledge of the outcomes of critically ill patients is crucial for health and government officials who are planning how to address local outbreaks. The factors associated with outcomes of critically ill patients with coronavirus disease 2019 (Covid-19) who required treatment in an intensive care unit (ICU) are yet to be determined. Methods: This was a retrospective registry-based case series of patients with laboratory-confirmed SARS-CoV-2 who were referred for ICU admission and treated in the ICUs of the 13 participating centers in Israel between 5 March and 27 April 2020. Demographic and clinical data including clinical management were collected and subjected to a multivariable analysis; primary outcome was mortality. Results: This study included 156 patients (median age = 72 years (range = 22–97 years)); 69% (108 of 156) were male. Eighty-nine percent (139 of 156) of patients had at least one comorbidity. One hundred three patients (66%) required invasive mechanical ventilation. As of 8 May 2020, the median length of stay in the ICU was 10 days (range = 0–37 days). The overall mortality rate was 56%; a multivariable regression model revealed that increasing age (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), the presence of sepsis (OR = 1.08 for each year of age, 95%CI = 1.03–1.13), and a shorter ICU stay(OR = 0.90 for each day, 95% CI = 0.84–0.96) were independent prognostic factors. Conclusions: In our case series, we found lower mortality rates than those in exhausted health systems. The results of our multivariable model suggest that further evaluation is needed of antiviral and antibacterial agents in the treatment of sepsis and secondary infection.

scholarly journals Management of invasive pulmonary aspergillosis in non-neutropenic critically ill patients

2007 ◽  
Vol 33 (10) ◽  
pp. 1694-1703 ◽  
Author(s):  
R. J. Trof ◽  
A. Beishuizen ◽  
Y. J. Debets-Ossenkopp ◽  
A. R. J. Girbes ◽  
A. B. J. Groeneveld
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: results from the prospective AspCOVID-19 study

2020 ◽  
Author(s):  
Tobias Lahmer
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Early Stage ◽  
Invasive Pulmonary Aspergillosis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Pulmonary Aspergillosis ◽  
Time Period ◽  
Incidence Risk ◽  
Standardized Screening

Background: Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. Methods: We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from bronchial aspirates. We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. Findings: CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p=0.340) and days of mechanical ventilation (20 versus 15 days; p=0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. Interpretation: CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.

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