Abstract
Rates of invasive aspergillosis (IA) among COVID-19 ICU patients seem to reach over 30% in certain settings. At Vienna General Hospital (VGH), all rooms in COVID-19 ICUs were put under negative pressure as a protective measure, thus increasing the risk of exposure to environmental pathogens for patients. Even though all ICU patients are surveilled for healthcare-associated infections (HAI), there were concerns that the routine protocol might not be sufficient for IA detection. We reviewed the electronic patient charts of all patients with COVID-19 admitted to ICUs between 1 March 2020 and 31 July 2021 for fungal co- or superinfections, comparing four diagnostic algorithms based on different recommendations for the diagnosis of IA (according to EORTC/MSG, BM-AspICU, IAPA and CAPA) to our routine surveillance protocol. We found that out of 252 patients who were admitted to the ICU during the study period, 25 (9.9%) fulfilled the criteria of probable or possible IA of at least one algorithm. The IAPA definitions detected 25 and the CAPA definition 23 probable and 2 possible cases, out of which only 16 were classified as hospital-acquired IA by routine surveillance. In conclusion, adjustment of the routine protocol using a classification system especially designed for respiratory viral illness seems useful for the surveillance of IA in a highly vulnerable patient cohort.
Highlights
Rates of invasive aspergillosis (IA) among COVID-19 ICU patients seem to reach over 30% in certain settings
Even though all ICU patients are surveilled for healthcare-associated infections (HAI), there were concerns that the routine protocol might not be sufficient for IA detection
We reviewed the electronic patient charts of all patients with COVID-19 admitted to ICUs between 1 March 2020 and 31 July 2021 for fungal co- or superinfections, comparing four diagnostic algorithms based on different recommendations for the diagnosis of IA to our routine surveillance protocol
Summary
Invasive aspergillosis (IA), which is most commonly caused by Aspergillus fumigatus [1–3], is a well-known complication in patients with hematological malignancies or bone marrow transplantation due to severe neutropenia [4,5]. It occurs in patients with severe respiratory conditions needing high-dose corticosteroid or other immunomodulating treatment [3]. Reports on IA rates among COVID-19 ICU patients vary, some authors have reported rates of over 30% [6,7]. Several factors seem to lead to the increased susceptibility of COVID-19 patients to IA, i.e., ARDS, prolonged hospital/ICU stay, prolonged mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) and therapy with corticosteroids [10]. The Centers for Disease Prevention and Control (CDC) recommend increased awareness regarding IA in
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