P155 A Mexican case series of COVID-19 - associated pulmonary aspergillosis

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMThe pandemic coronavirus disease 2019 (COVID-19) has been in the scope for invasive pulmonary aspergillosis (IPA) after the first reports worldwide, now known as CAPA.Objectiveto describe a case series of CAPA documented in four intensive care units while treating patients with severe COVID-19 pneumonia in order to describe clinical characteristics, cultures result and MICs from Aspergillus isolations, and treatments.MethodsA prospective and descriptive study was performed from March 2020 to February 2022 in four tertiary level hospitals that treated COVID-19 patients in Mexico. We followed every single culture coming from the COVID-19 ICU, Aspergillus positive cultures had morphologic identification, and the MICs were obtained by broth microdilution. We did not interfere in the treatment.ResultsDuring 24 months of follow-up of patients with severe COVID-19 we found 17 adult cases with a mold identification, from those, 14 patients fit in the possible CAPA definition according to ECMM/ISHAM, and the remaining 3 were treated after expert opinion. The baseline characteristics of overall 47% had diabetes, and 41% were obese. Of the 14 cases included as a possible CAPA all of them had acute severe respiratory syndrome (average PaO2/FiO2 134 mmHg), 64% were in prone position, 78% had steroids at ICU admission, 92% had antibiotics at ICU. The computed tomography pattern predominantly associated were pulmonary infiltrates, nodules and cavitation. Only 2 patients (14%) had a positive galactomannan (>4.5) from non-bronchoscopic lavage. We had 9 Aspergillus fumigatus isolations and 4 A. niger, 1 A. flavus, 6 patients received voriconazole, 3 patients received isavuconazole, 1 anidulafungin and liposomal amphotericin B were used in 1 patient each respectively. The predominant MIC from isolations were ≥64 μg/ml for fluconazole, and <0.5 μg/ml for voriconazole, also all of them had MIC equal or <0.75 μg/ml for isavuconazole and 0.015 μg/ml for anidulafungin. A total of 50% of the patients had a CAPA-related death.ConclusionsCAPA is still a difficult entity to think of for diagnosis and treatment in severely ill COVID-19 patients. What predominates like other series were obesity, use of steroids, and ARDS. The contribution of small Mexican series like ours (based on the new guidelines) will allow to understand that CAPA could be no longer a rare fungal infectious disease complication in severely ill COVID-19 patients. An extended consensus must be made for those possible CAPA definition cases.