scholarly journals Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Anahita Rouzé ◽  
Elise Lemaitre ◽  
Ignacio Martin-Loeches ◽  
Pedro Povoa ◽  
Emili Diaz ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Invasive Mechanical Ventilation ◽  
Invasive Pulmonary Aspergillosis ◽  
Group 14 ◽  
Pulmonary Aspergillosis ◽  
Multicenter Studies ◽  
Clinical Trial Registration ◽  
Study Population ◽  
Comparative Cohort Study ◽  
Influenza Pneumonia

Abstract Background Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. Objectives To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. Methods This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. Results A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. Conclusions Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.

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&lt; 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

Translational immunoPET/MR imaging of invasive pulmonary aspergillosis

2019 ◽  
Author(s):  
J Schwenck ◽  
N Beziere ◽  
A Maurer ◽  
AM Wild ◽  
H Henneberg ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Pregnancy outcomes in women receiving growth hormone replacement therapy enrolled in the NordiNet® International Outcome Study (IOS) and the American Norditropin® Studies: Web-Enabled Research (ANSWER) Program

Pituitary ◽  
2021 ◽  
Author(s):  
Beverly M. K. Biller ◽  
Charlotte Höybye ◽  
Paul Carroll ◽  
Murray B. Gordon ◽  
Anna Camilla Birkegård ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Outcome Study ◽  
Real World Data ◽  
Multicenter Studies ◽  
Clinical Trial Registration ◽  
Normal Delivery ◽  
Growth Hormone Replacement Therapy ◽  
Gh Replacement

Abstract Purpose Data on the safety of growth hormone (GH) replacement therapy during pregnancy are limited. We report a combined analysis of data from pregnant women treated with GH while enrolled in two non-interventional, multicenter studies: NordiNet® International Outcome Study (IOS) and the American Norditropin® Studies: Web-Enabled Research (ANSWER) Program. Methods Pregnancy data were pooled from NordiNet® IOS and the ANSWER Program. Data were collected during routine clinic visits by participating physicians using a web-based system. Patients exposed to GH replacement therapy during pregnancy were included in the analysis. Results The study population included 40 female patients with typical causes of adult GH deficiency (GHD). Overall, there were 54 pregnancies. Of these, 47 were exposed to GH between conception and delivery. In 48.9% of pregnancies exposed to GH, the dose was > 0.6 mg/day. GH was continued past conception and then stopped during the first, second, and third trimester, in 27.7%, 17.0%, and 2.1% of pregnancies, respectively. In 29.8%, GH was continued throughout pregnancy, with an unchanged dose in most cases. Of the 47 GH-exposed pregnancies, 37 (78.7%) progressed to normal delivery. There were three adverse events reported in two pregnancies. Conclusion These real-world data suggest that there were no new safety signals related to GH exposure in women with GHD during pregnancy. These results are consistent with findings from previous studies reporting data in pregnancies exposed to GH at conception or throughout pregnancy. This observational study in additional pregnancies provides further evidence that GH exposure does not adversely affect pregnancy outcome. Clinical trial registration: ClinicalTrials.gov NCT00960128 (date of registration: August 13, 2009) and NCT01009905 (date of registration: November 5, 2009).

Sign in / Sign up

Export Citation Format

Share Document