Erratum: A Clinical Algorithm to Diagnose Invasive Pulmonary Aspergillosis in Critically Ill Patients

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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Prevalence and outcome of invasive pulmonary aspergillosis in critically ill patients with liver cirrhosis: an observational study

Scientific Reports ◽

10.1038/s41598-019-48183-4 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Tobias Lahmer ◽

Andreas Brandl ◽

Sebastian Rasch ◽

Gonzalo Batres Baires ◽

Roland M. Schmid ◽

...

Keyword(s):

Liver Cirrhosis ◽

Observational Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Invasive Pulmonary Aspergillosis ◽

Pulmonary Aspergillosis

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Usefulness of ICU criteria for diagnosis of invasive pulmonary aspergillosis in nonhematologic critically ill patients

Medical Mycology ◽

10.1093/mmy/myz062 ◽

2019 ◽

Vol 58 (3) ◽

pp. 275-281

Author(s):

Song-I Lee ◽

Heungsup Sung ◽

Sang-Bum Hong ◽

Chae-Man Lim ◽

Younsuck Koh ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Hematologic Malignancy ◽

Invasive Pulmonary Aspergillosis ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Pulmonary Aspergillosis ◽

Treatment Groups ◽

Significant Difference ◽

Criteria For Diagnosis

Abstract Invasive pulmonary aspergillosis (IPA) is a life-threatening disease in the intensive care unit (ICU). The ICU criteria were proposed to diagnose IPA in critically ill patients. This study aims to evaluate the usefulness of ICU criteria for diagnosis and treatment of IPA in nonhematologic patients in the ICU. We retrospectively reviewed 103 ICU patients with positive galactomannan test in blood and respiratory tract from January 1, 2016, to May 31, 2017. We excluded patients with hematologic malignancy. We divided the treatment and non-treatment groups according to the IPA treatment. We compared the baseline characteristics and outcomes between two groups and the agreement with ICU criteria. There were 49 patients in treatment groups and 54 patients in non-treatment groups. There were more cases of solid organ transplantation (P = .003), immunosuppressive therapy (P < .001) and bacterial viral coinfection (P = .048) in the treatment group compared to nontreatment group. There was no statistically significant difference in mortality, the use of ventilator, and septic shock between the two groups. The agreement rate between the putative group and treatment was low (59.2%). There was no statistically significant difference in outcome between the putative and colonization groups according to the ICU criteria in each group. The treatment of IPA based on the symptom, radiologic finding and galactomannan test did not showed the better outcome. Also, the treatment based on the ICU criteria didn’t show the difference of outcome. The new criteria for diagnosis of IPA in critically ill patients are needed.

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