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Invasive fungal infections among critically ill adult COVID-19 patients: First experiences from the national centre in Hungary - 02/12/21

Doi : 10.1016/j.mycmed.2021.101198 
Balint Gergely Szabo a, b, , Botond Lakatos a, Ilona Bobek a, Edina Szabo a, Janos Szlavik a, István Vályi-Nagy a
a South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Saint Ladislaus Campus (H-1097 Albert Florian ut 5‑7.), Budapest, Hungary 
b Semmelweis University, School of PhD Studies (H-1085 Ulloi ut 26.), Budapest, Hungary 

Corresponding author at: H-1097 Albert Florian ut 5‑7., Budapest, HungaryH-1097 Albert Florian ut 5‑7.BudapestHungary

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Highlights

We assessed invasive fungal infections (IFI) among critically ill COVID-19 patients.
Among 90 eligible patients, 20 had IFI with an incidence of 2.02 episodes / 100 patient-days.
Candidaemia was 45%, probable/putative invasive pulmonary aspergillosis was 80% among study patients.
In-hospital all-cause mortality was 60% with a median time of 31.0±37.0 days.

El texto completo de este artículo está disponible en PDF.

Abstract

Introduction

Data suggests that invasive fungal infections (IFI) might complicate COVID-19. Our goal was to describe characteristics of IFI among critically ill COVID-19 adults.

Methods

A retrospective observational case-series analysis was done between March–July 2020. Consecutive patients with critical COVID-19 were eligible, and have been included when proven or putative/probable IFI could be confirmed during their course. For COVID-19 diagnosis, ECDC definitions and WHO severity criteria were followed. Candidaemia was diagnosed according to the ESCMID 2012 guideline. Invasive pulmonary aspergillosis (IPA) was defined following EORTC/MSG, ECMM/ISHAM and modified AspICU criteria. Outcome variables were rates of IFIs, in-hospital all-cause mortality, rate and time to negative respiratory SARS-CoV-2 PCR.

Results

From 90 eligible patients, 20 (22.2%) fulfilled criteria for IFI. Incidence rate for IFI was 2.02 per 100 patient-days at ICU. Patients were mostly elderly males with significant comorbidities, requiring mechanical ventilation because of ARDS. IFI could be classified as candidaemia in 7/20 (40%), putative/probable IPA in 16/20 (80.0%). Isolated species of candidaemia episodes were Candida albicans (4/9, 44.4%), Candida glabrata (3/9, 33.3%), Candida parapsilosis (1/9, 11.1%), Candida metapsilosis (1/9, 11.1%). Mold isolates from lower respiratory tract were Aspergillus fumigatus, BAL galactomannan positivity was prevalent (16/20, 80.0%). Mortality was 12/20 (60.0%) with a median time to death of 31.0±37.0 (5–89) days. Only 9/20 (45.0%) patients reached SARS-CoV-2 PCR negativity after a median time of 20.0±12.0 (3–38) days.

Conclusion

In this small cohort of critically ill COVID-19 adults, morbidity and mortality related to invasive fungal infections proved to be significant.

El texto completo de este artículo está disponible en PDF.

Keywords : COVID-19, Invasive fungal infection, Aspergillosis, Candidaemia, Cytokine storm

Abbreviations : AMB, ANI, ARDS, AS, BAL, BAR, BDG, BID, BSI, BW, CAS, CHF, COPD, COVID-19, CRP, CS, CT, DEX, DLBCL, DM, ECDC, EH, EUCAST, ECMM, F, FLU, FVP, GM, HCQ, HI, I, IDSA, IFI, IPA, ISA, ISHAM, ITR, iv., IVIG, L-AMB, LDH, LPV/r, LOS, M, MIC, MP, MYC, PCR, po., POS, QD, R, S, SARS-CoV-2, TID, TOC, VAP, VOR


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© 2021  The Authors. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 31 - N° 4

Artículo 101198- décembre 2021 Regresar al número
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