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A National Strategy to Diagnose Coronavirus Disease 2019-Associated Invasive Fungal Disease in the Intensive Care
P Lewis White1, Rishi Dhillon1, Alan Cordey1
1Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, UK.
Background:
Fungal coinfection is a recognized complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress are being reported, but comprehensive data are lacking. The aim of this study was to determine the incidence, risk factors, and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress.
Methods:
An evaluation of a national, multicenter, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients.
Results:
One-hundred and thirty-five adults (median age: 57, M/F: 2.2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12.6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P = .0387). The mortality rate was reduced by the use of antifungal therapy (mortality: 38.5% in patients receiving therapy vs 90% in patients not receiving therapy (P = .008). The use of corticosteroids (P = .007) and history of chronic respiratory disease (P = .05) increased the likelihood of aspergillosis.
Conclusions:
Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.
Insights
Fungal infections are common in critically ill COVID-19 patients, increasing mortality. Early diagnosis and antifungal treatment significantly improve survival rates in these patients.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Mycology
Background:
- Fungal coinfections complicate respiratory virus infections, raising morbidity and mortality.
- Aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress is increasingly reported.
- Comprehensive data on invasive fungal disease in COVID-19 patients are lacking.
Purpose of the Study:
- To determine the incidence of invasive fungal disease in adult COVID-19 patients with severe respiratory distress.
- To identify risk factors associated with invasive fungal disease in this population.
- To assess the impact of invasive fungal disease on mortality.
Main Methods:
- A national, multicenter, prospective cohort study.
- Evaluation of an enhanced testing strategy for diagnosing invasive fungal disease.
- Development of criteria to define aspergillosis in COVID-19 patients.
Main Results:
- The incidence of fungal disease was 26.7% (14.1% aspergillosis, 12.6% yeast infections) in 135 screened adults.
- Overall mortality was 38%, with higher rates in patients with fungal disease (53%) versus without (31%).
- Antifungal therapy reduced mortality (38.5% vs 90%), while corticosteroids and chronic respiratory disease history increased aspergillosis likelihood.
Conclusions:
- Invasive fungal disease is frequent in critically ill, mechanically ventilated COVID-19 patients.
- Antifungal therapy demonstrated a survival benefit, validating proposed diagnostic criteria.
- Strategic screening and antifungal prophylaxis for high-risk patients may improve COVID-19 management.
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