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

A Alanio, S Dellière, S Fodil, S Bretagne… - The Lancet …, 2020 - thelancet.com
The Lancet Respiratory Medicine, 2020thelancet.com
About 5% of patients with coronavirus disease 2019 (COVID-19) require intensive care unit
(ICU) management. 1 These patients are at high risk of developing secondary infections
including invasive pulmonary aspergillosis (IPA). 2 First reported with H1N1 influenza, IPA
represents a frequent (20–30%) and early-onset complication (median, 3 days post-ICU
admission) in critically ill patients with influenza, leading to enhanced illness severity and
mortality (40–60%). 3, 4 Most cases have been observed in non-immunocompromised …
About 5% of patients with coronavirus disease 2019 (COVID-19) require intensive care unit (ICU) management. 1 These patients are at high risk of developing secondary infections including invasive pulmonary aspergillosis (IPA). 2 First reported with H1N1 influenza, IPA represents a frequent (20–30%) and early-onset complication (median, 3 days post-ICU admission) in critically ill patients with influenza, leading to enhanced illness severity and mortality (40–60%). 3, 4 Most cases have been observed in non-immunocompromised patients, questioning the applicability of the European Organization for Research and Treatment of Cancer Mycoses Study Group (EORTC-MSG) consensus criteria used to define aspergillosis in immunocompromised patients. 5 Therefore, an algorithm to discriminate Aspergillus spp colonisation from putative IPA was developed for patients in ICU on the basis of mycological criteria combining culture from respiratory specimens and galactomannan detection in the bronchoalveolar lavage (BAL) and serum. 4, 6
Parallelling what has been reported in influenza patients, we designed this prospective observational study to investigate IPA risk in critically ill patients with COVID-19. The patients were classified by means of the EORTC-MSG criteria5 (if immunocompromised) or the influenza-associated IPA criteria4 combined with serum β-D-glucan and quantitative real-time PCR (qPCR) 7 done in the serum or pulmonary specimens (if non-immunocompromised). Putative IPA was considered if Aspergillus spp were identified in BAL culture; or if two of the following conditions were met (ie, presence of Aspergillus spp in bronchial aspiration [BA] culture; positive Aspergillus fumigatus qPCR in BAL, BA, or serum; 8 galactomannan
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