COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave - Sorbonne Université
Journal Articles Microbiology Spectrum Year : 2021

COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave

1 CNRMA - Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals
2 GEMS - Génomique évolutive, modélisation et santé
3 Laboratoire de Parasitologie-Mycologie [CHU Saint Louis, Paris]
4 Mycologie moléculaire - Molecular Mycology
5 CHU Henri Mondor [Créteil]
6 Laboratoire de Parasitologie et de Mycologie Médicale [Strasbourg]
7 Laboratoire de parasitologie et de mycologie médicales [CHU Amiens]
8 Service de parasitologie et mycologie [CHRU de Besançon]
9 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
10 CHU Pitié-Salpêtrière [AP-HP]
11 CIMI - Centre d'Immunologie et des Maladies Infectieuses
12 Service de parasitologie et mycologie médicale [Hôpital de la Croix Rousse, Lyon]
13 CHU Rouen
14 Laboratoire de Parasitologie-Mycologie (CHU de Montpellier)
15 Laboratoire de parasitologie mycologie (CHU de Dijon)
16 CHU Bordeaux
17 Hôpital Cochin [AP-HP]
18 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
19 Laboratoire de Parasitologie-Mycologie, Nice
20 CHU Reims - Hôpital universitaire Robert Debré [Reims]
21 ESCAPE - Epidémiosurveillance de protozooses à transmission alimentaire et vectorielle
22 Imagine - U1163 - Imagine - Institut des maladies génétiques (IHU)
23 Hôpital Necker - Enfants Malades [AP-HP]
24 Centre hospitalier [Valenciennes, Nord]
25 Laboratoire de Parasitologie et Mycologiede [CHRU Brest]
26 CHU Nîmes - Hôpital Universitaire Carémeau [Nîmes]
27 Service de Parasitologie [Avicenne]
28 CHU Montpellier
29 IHU Marseille - Institut Hospitalier Universitaire Méditerranée Infection
30 VITROME - Vecteurs - Infections tropicales et méditerranéennes
31 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
32 Irset - Institut de recherche en santé, environnement et travail
33 CHU Clermont-Ferrand
34 Hôpital Raymond Poincaré [AP-HP]
35 Hôpital Ambroise Paré [AP-HP]
36 Centre Hospitalier de Saint-Denis [Ile-de-France]
37 CHU de Martinique - Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique]
38 Centre Hospitalier de Beauvais
39 Mycologie moléculaire - Molecular Mycology
Françoise Botterel
Damien Costa
Sophie Cassaing
Milène Sasso
Lucile Cadot
  • Function : Author
Alain Le Coustumier
  • Function : Author

Abstract

The aim of this study was to evaluate diagnostic means, host factors, delay of occurrence, and outcome of patients with COVID-19 pneumonia and fungal coinfections in the intensive care unit (ICU). From 1 February to 31 May 2020, we anonymously recorded COVID-19-associated pulmonary aspergillosis (CAPA), fungemia (CA-fungemia), and pneumocystosis (CA-PCP) from 36 centers, including results on fungal biomarkers in respiratory specimens and serum. We collected data from 154 episodes of CAPA, 81 of CA-fungemia, 17 of CA-PCP, and 5 of other mold infections from 244 patients (male/female [M/F] ratio = 3.5; mean age, 64.7 ± 10.8 years). CA-PCP occurred first after ICU admission (median, 1 day; interquartile range [IQR], 0 to 3 days), followed by CAPA (9 days; IQR, 5 to 13 days), and then CA-fungemia (16 days; IQR, 12 to 23 days) (P < 10-4). For CAPA, the presence of several mycological criteria was associated with death (P < 10-4). Serum galactomannan was rarely positive (<20%). The mortality rates were 76.7% (23/30) in patients with host factors for invasive fungal disease, 45.2% (14/31) in those with a preexisting pulmonary condition, and 36.6% (34/93) in the remaining patients (P = 0.001). Antimold treatment did not alter prognosis (P = 0.370). Candida albicans was responsible for 59.3% of CA-fungemias, with a global mortality of 45.7%. For CA-PCP, 58.8% of the episodes occurred in patients with known host factors of PCP, and the mortality rate was 29.5%. CAPA may be in part hospital acquired and could benefit from antifungal prescription at the first positive biomarker result. CA-fungemia appeared linked to ICU stay without COVID-19 specificity, while CA-PCP may not really be a concern in the ICU. Improved diagnostic strategy for fungal markers in ICU patients with COVID-19 should support these hypotheses. IMPORTANCE To diagnose fungal coinfections in patients with COVID-19 in the intensive care unit, it is necessary to implement the correct treatment and to prevent them if possible. For COVID-19-associated pulmonary aspergillosis (CAPA), respiratory specimens remain the best approach since serum biomarkers are rarely positive. Timing of occurrence suggests that CAPA could be hospital acquired. The associated mortality varies from 36.6% to 76.7% when no host factors or host factors of invasive fungal diseases are present, respectively. Fungemias occurred after 2 weeks in ICUs and are associated with a mortality rate of 45.7%. Candida albicans is the first yeast species recovered, with no specificity linked to COVID-19. Pneumocystosis was mainly found in patients with known immunodepression. The diagnosis occurred at the entry in ICUs and not afterwards, suggesting that if Pneumocystis jirovecii plays a role, it is upstream of the hospitalization in the ICU.
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Dates and versions

hal-03404538 , version 1 (26-10-2021)

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Stéphane Bretagne, Karine Sitbon, Françoise Botterel, Sarah Dellière, Valérie Letscher-Bru, et al.. COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave. Microbiology Spectrum, 2021, 9 (2), pp.e0113821. ⟨10.1128/Spectrum.01138-21⟩. ⟨hal-03404538⟩
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