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

• DOI: 10.1128/spectrum.01138-21
• Publication Date: 2021-10-20T14:44:13Z
• Authors: Stéphane Bretagne; Karine Sitbon; Françoise Botterel; Sarah Dellière; Valérie Letscher-Bru; Taieb Chouaki; Anne-Pauline Bell...; Christine Bonnal; Arnault Fekkar; Florence Persat; Damien Costa; Nathalie Bourgeois; Frédéric Dalle; Florian Lussac-So...; André Paugam; Sophie Cassaing; Lilia Hasseine; Antoine Huguenin; Nadia Guennouni; Edith Mazars; Solène Le Gal; Milène Sasso; Sophie Brun; Lucile Cadot; Carole Cassagne; Estelle Cateau; Jean-Pierre Gangneux; Maxime Moniot; Anne-Laure Roux; Céline Tournus; Nicole Desbois-No...; Alain Le Coustumier; Olivier Moquet; Alexandre Alanio; Françoise Dromer
• Keywords: Fungemia; Interquartile range; Pneumocystosis

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