Incidence, risk factors, timing, and outcome of influenza versus COVID-19-associated putative invasive aspergillosis.

Camille Sarrazyn,Jens T Van Praet,Sofie Dhaese,Birgit Demey,Marijke Reynders,Stefaan Vandecasteele

doi:10.1017/ice.2020.460

Camille Sarrazyn, Jens T Van Praet + Show 4 more

Open Access

https://doi.org/10.1017/ice.2020.460

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Abstract

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Highlights

For the analysis of COVID-19–associated IPA, we collected the data for all consecutively admitted outpatients between March 11, 2020, and April 17, 2020, with a positive nasopharyngeal swab (RT-PCR testing) for and/or IgG antibodies (MPIA on Architect-I System from Abbott, Sligo, Ireland) against severe acute respiratory coronavirus virus 2 (SARS-CoV-2) upon admission (n = 131; median age, 67 years; IQR, 56–79; 40% female)
For the definition of IPA, we used ‘putative IPA’ because the optimal criteria for COVID-19–associated IPA have not been established.[5]. This definition requires the identification of Aspergillus spp in culture of bronchoalveolar lavage fluid or meeting at least 2 of the following conditions: the identification of Aspergillus spp in a culture of bronchial aspirate, positive galactomannan detection in bronchial aspirate or bronchoalveolar lavage fluid (Platelia antigen EIA from Bio-Rad, Berkeley, CA, with a cut-off index of > 1.00) or positive RT-PCR for Aspergillus spp in bronchial aspirate or bronchoalveolar lavage fluid
Putative IPA was diagnosed in 5 patients of the influenza cohort (3.5%) and 4 of the COVID-19 cohort (3%), conferring to incidences of 218.7 per 100 patient years and 118.8 per 100 patient years, respectively

Summary

Introduction

The latter 2 tests are routinely performed in our laboratory on all lower respiratory tract samples. For COVID-19 patients, the microbiological tests were performed on sputum or bronchial aspirate, which was routinely collected 3 times weekly from ventilated patients, given the risk of aerosolization during bronchoscopy.[6] Patients were considered at risk for IPA the first 28 days after diagnosis of viral illness, or until death. Negative binomial regression was used to calculate the incidence and 95% confidence interval of IPA in patients with influenza or COVID-19. Putative IPA was diagnosed in 5 patients of the influenza cohort (3.5%) and 4 of the COVID-19 cohort (3%), conferring to incidences of 218.7 per 100 patient years (95% CI, 40.1– 1,627.9) and 118.8 per 100 patient years (95% CI, 21.6–834.2), respectively.

Results

Conclusion