Multinational Observational Cohort Study of COVID-19-Associated Pulmonary Aspergillosis1.

Nico Janssen ,Paul E Verweij,Fabienne Tamion,Lore Vanderbeke,Damien Costa,Saad Nseir,Jochem B Buil,Boualem Sendid,Joost Wauters,Hervé Dupont,Julien Maizel,Josje Altenburg,Marijke Reynders,Katrien Lagrou,Simon Feys,Marc Bourgeois,Lynn Rutsaert,Mehmet Ergün,Piet Lormans,Cato Jacobs,Rémy Nyga,Frank L Van De Veerdonk,Yves Debavaye,Albert Dunbar,Karin Van Dijk,N Van Regenmortel ,Hans I Van Der Spoel ,Jeroen Schouten ,Bart Rijnders ,Catherine S C Bouman ,Taïeb Chouaki ,Roger J M Brüggemann

doi:10.3201/eid2711.211174

Abstract

We performed an observational study to investigate intensive care unit incidence, risk factors, and outcomes of coronavirus disease–associated pulmonary aspergillosis (CAPA). We found 10%–15% CAPA incidence among 823 patients in 2 cohorts. Several factors were independently associated with CAPA in 1 cohort and mortality rates were 43%–52%.

Highlights

We performed an observational study to investigate intensive care unit incidence, risk factors, and outcomes of coronavirus disease–associated pulmonary aspergillosis (CAPA)
We found CAPA incidence was 10%–15%, corresponding to the 14%–19% reported in other studies (8,9)
Discovery cohort CAPA incidence was similar to influenza-associated pulmonary aspergillosis (IAPA) incidence in intensive care units (ICUs) (12,13)

Summary

Days between ICU admission and first

Associated pulmonary aspergillosis; COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease; Ct, cycle threshold; CT, computed tomography; ECMO, extracorporeal membrane oxygenation; EORTC/MSGERC, European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium; GM, galactomannan; ICU, intensive care unit; IQR, interquartile range; LOS, length of stay; NA, not applicable; NBL, nonbronchoscopic lavage; OD, optical density; RRT, renal replacement therapy; SCT, stem cell transplantation; SOT, solid organ transplant. COPD, HIV/AIDS, and use of other immunosuppressant drugs before ICU admission were associated with CAPA (Appendix Figure 1, panel A). We included 304 patients in the validation cohort (Figure 1, panel B); median age was 63 years, 25% were male, and 76% required invasive mechanical ventilation (Table 2; Appendix Tables [9, 10]). Use of corticosteroids before or during ICU admission or other immunosuppressant drugs before ICU admission were not independently associated with CAPA (Appendix Figure 1, panel C). Corticosteroid use during ICU stay was not significantly different between the CAPA and CAPAexcluded groups (p = 0.82) in the validation cohort. CAPA was not independently associated with ICU death, but older age and AKI during ICU admission were (Appendix Table 10, Figure 1, panel D)

Conclusions

Findings

Positive BALF culture