1. Invasive fungal infections among critically ill adult COVID-19 patients: First experiences from the national centre in Hungary
- Author
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János Szlávik, Botond Lakatos, Edina Szabó, István Vályi-Nagy, Balint Gergely Szabo, and Ilona Bobek
- Subjects
VAP, ventilator-associated pneumonia ,Male ,ISA, isavuconazole ,ISHAM, International Society for Human and Animal Mycology ,ARDS ,COVID-19, coronavirus disease-19 ,MP, methylprednisolone ,HI, Horowitz index (PaO2/FiO2) ,L-AMB, liposomal amphotericin-B ,IDSA, Infectious Disease Society of America ,VOR, voriconazole ,CHF, chronic heart failure ,Cytokine storm ,Candida parapsilosis ,Aspergillosis ,iv., intravenously ,chemistry.chemical_compound ,Invasive fungal infection ,EUCAST, European Committee on Antimicrobial Susceptibility Testing ,IPA, invasive pulmonary aspergillosis ,PCR, polymerase chain reaction ,COVID-19 Testing ,IFI, invasive fungal infection ,QD, once daily ,DM, diabetes mellitus ,LPV/r, lopinavir/ritonavir ,Medicine ,Candida albicans ,S, sensitive ,po., orally (per os) ,Aged, 80 and over ,Invasive Pulmonary Aspergillosis ,LDH, lactate dehydrogenase ,biology ,BW, body weight ,I, intermediate susceptible ,CAS, caspofungin ,FLU, fluconazole ,CS, cytokine storm ,Middle Aged ,EH, essential hypertension ,CT, computed tomography ,FVP, favipiravir ,Infectious Diseases ,Cohort ,CRP, C-reactive protein ,M, male ,Female ,BAL, bronchoalveolar lavage ,IVIG, intravenus immunoglobulin ,AS, atherosclerosis ,POS, posaconazole ,DLBCL, diffuse large B-cell lymphoma ,ECMM, European Confederation of Medical Mycology ,Research Paper ,BDG, beta-D-glucan ,AMB, amphotericin-B ,Adult ,medicine.medical_specialty ,MYC, micafungin ,Critical Illness ,DEX, dexamethasone ,Galactomannan ,Candidaemia ,ANI, anidulafungin ,Internal medicine ,BID, twice daily ,ECDC, European Centre for Disease Prevention and Control ,MIC, minimal inhibitory concentration ,Humans ,LOS, lenght of stay ,TID, three times daily ,ARDS, acute respiratory distress syndrome ,Aged ,Retrospective Studies ,Hungary ,GM, galactomannan ,Candida glabrata ,business.industry ,COVID-19 ,F, female ,ITR, itraconazole ,Candidemia ,HCQ, hydroxychloroquine ,R, resistant ,Guideline ,biology.organism_classification ,medicine.disease ,BAR, baricitinib ,COPD, chronic obstructive pulmonary disease ,chemistry ,TOC, tocilizumab ,BSI, bloodstream-infection ,business ,SARS-CoV-2, severe acute respiratory syndrome coronavirus-2 ,Invasive Fungal Infections - Abstract
Introduction Data suggests that invasive fungal infections (IFI) might complicate COVID-19. Our goal was to describe characteristics of IFI among critically ill COVID-19 adults. Methods A retrospective observational case-series analysis was done between March–July 2020. Consecutive patients with critical COVID-19 were eligible, and have been included when proven or putative/probable IFI could be confirmed during their course. For COVID-19 diagnosis, ECDC definitions and WHO severity criteria were followed. Candidaemia was diagnosed according to the ESCMID 2012 guideline. Invasive pulmonary aspergillosis (IPA) was defined following EORTC/MSG, ECMM/ISHAM and modified AspICU criteria. Outcome variables were rates of IFIs, in-hospital all-cause mortality, rate and time to negative respiratory SARS-CoV-2 PCR. Results From 90 eligible patients, 20 (22.2%) fulfilled criteria for IFI. Incidence rate for IFI was 2.02 per 100 patient-days at ICU. Patients were mostly elderly males with significant comorbidities, requiring mechanical ventilation because of ARDS. IFI could be classified as candidaemia in 7/20 (40%), putative/probable IPA in 16/20 (80.0%). Isolated species of candidaemia episodes were Candida albicans (4/9, 44.4%), Candida glabrata (3/9, 33.3%), Candida parapsilosis (1/9, 11.1%), Candida metapsilosis (1/9, 11.1%). Mold isolates from lower respiratory tract were Aspergillus fumigatus, BAL galactomannan positivity was prevalent (16/20, 80.0%). Mortality was 12/20 (60.0%) with a median time to death of 31.0±37.0 (5–89) days. Only 9/20 (45.0%) patients reached SARS-CoV-2 PCR negativity after a median time of 20.0±12.0 (3–38) days. Conclusion In this small cohort of critically ill COVID-19 adults, morbidity and mortality related to invasive fungal infections proved to be significant.
- Published
- 2021
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