The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients.

IF 1.8 Q3 RESPIRATORY SYSTEM Advances in respiratory medicine Pub Date : 2023-09-02 DOI:10.3390/arm91050027
Heba Osman, Asra N Shaik, Paul L Nguyen, Zachary Cantor, Mirna Kaafarani, Ayman O Soubani
{"title":"The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients.","authors":"Heba Osman,&nbsp;Asra N Shaik,&nbsp;Paul L Nguyen,&nbsp;Zachary Cantor,&nbsp;Mirna Kaafarani,&nbsp;Ayman O Soubani","doi":"10.3390/arm91050027","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objective</b>: Critically ill patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications, including invasive aspergillosis. Our study aimed to characterize the clinical significance and outcome of <i>Aspergillus</i> species isolated from lower-respiratory-tract samples of critically ill OVID-19 patients at a single center. <b>Design</b>: We conducted a retrospective cohort study to evaluate the characteristics of patients with COVID-19 and <i>aspergillus</i> isolated from the lower respiratory tract and to identify predictors of outcomes in this population. <b>Setting</b>: The setting was a single-center hospital system within the metropolitan Detroit region. <b>Results</b>: The prevalence of <i>Aspergillus</i> isolated in hospitalized COVID-19 patients was 1.18% (30/2461 patients), and it was 4.6% in critically ill ICU patients with COVID-19. Probable COVID-19-associated invasive pulmonary aspergillosis (CAPA) was found in 21 critically ill patients, and 9 cases were classified as colonization. The in-hospital mortality of critically ill patients with CAPA and those with <i>aspergillus</i> colonization were high but not significantly different (76% vs. 67%, <i>p</i> = 1.00). Furthermore, the in-hospital mortality for ICU patients with or without <i>Aspergillus</i> isolated was not significantly different 73.3% vs. 64.5%, respectively (OR 1.53, CI 0.64-4.06, <i>p</i> = 0.43). In patients in whom <i>Aspergillus</i> was isolated, antifungal therapy (<i>p</i> = 0.035, OR 12.3, CI 1.74-252); vasopressors (0.016, OR 10.6, CI 1.75-81.8); and a higher mSOFA score (<i>p</i> = 0.043, OR 1.29 CI 1.03-1.72) were associated with a worse outcome. In a multivariable model adjusting for other significant variables, FiO<sub>2</sub> was the only variable associated with in-hospital mortality in patients in whom <i>Aspergillus</i> was isolated (OR 1.07, 95% CI 1.01-1.27). <b>Conclusions</b>: The isolation of <i>Aspergillus</i> from lower-respiratory-tract samples of critically ill patients with COVID-19 is associated with high mortality. It is important to have a low threshold for superimposed infections such as CAPA in critically ill patients with COVID-19.</p>","PeriodicalId":7391,"journal":{"name":"Advances in respiratory medicine","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2023-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10514834/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in respiratory medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/arm91050027","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Critically ill patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications, including invasive aspergillosis. Our study aimed to characterize the clinical significance and outcome of Aspergillus species isolated from lower-respiratory-tract samples of critically ill OVID-19 patients at a single center. Design: We conducted a retrospective cohort study to evaluate the characteristics of patients with COVID-19 and aspergillus isolated from the lower respiratory tract and to identify predictors of outcomes in this population. Setting: The setting was a single-center hospital system within the metropolitan Detroit region. Results: The prevalence of Aspergillus isolated in hospitalized COVID-19 patients was 1.18% (30/2461 patients), and it was 4.6% in critically ill ICU patients with COVID-19. Probable COVID-19-associated invasive pulmonary aspergillosis (CAPA) was found in 21 critically ill patients, and 9 cases were classified as colonization. The in-hospital mortality of critically ill patients with CAPA and those with aspergillus colonization were high but not significantly different (76% vs. 67%, p = 1.00). Furthermore, the in-hospital mortality for ICU patients with or without Aspergillus isolated was not significantly different 73.3% vs. 64.5%, respectively (OR 1.53, CI 0.64-4.06, p = 0.43). In patients in whom Aspergillus was isolated, antifungal therapy (p = 0.035, OR 12.3, CI 1.74-252); vasopressors (0.016, OR 10.6, CI 1.75-81.8); and a higher mSOFA score (p = 0.043, OR 1.29 CI 1.03-1.72) were associated with a worse outcome. In a multivariable model adjusting for other significant variables, FiO2 was the only variable associated with in-hospital mortality in patients in whom Aspergillus was isolated (OR 1.07, 95% CI 1.01-1.27). Conclusions: The isolation of Aspergillus from lower-respiratory-tract samples of critically ill patients with COVID-19 is associated with high mortality. It is important to have a low threshold for superimposed infections such as CAPA in critically ill patients with COVID-19.

Abstract Image

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
危重COVID-19阳性患者下呼吸道样本中曲霉菌检测的临床意义。
目的:由病毒感染引起的急性呼吸窘迫综合征(ARDS)危重患者有继发并发症的风险,包括侵袭性曲霉菌病。我们的研究旨在描述在一个中心从危重OVID-19患者的下呼吸道样本中分离出的曲霉属物种的临床意义和结果。设计:我们进行了一项回顾性队列研究,以评估新冠肺炎和下呼吸道分离曲霉菌患者的特征,并确定该人群的预后预测因素。环境:该环境是底特律大都市地区的一个单中心医院系统。结果:新冠肺炎住院患者分离曲霉的患病率为1.18%(30/2461例),新冠肺炎重症监护室患者分离曲霉患病率为4.6%。在21例危重患者中发现了可能的COVID-19相关侵袭性肺曲膜炎(CAPA),9例被归类为定植。CAPA危重患者和曲霉菌定植患者的住院死亡率很高,但没有显著差异(76%对67%,p=0.00)。此外,分离或不分离曲霉菌的ICU患者的住院死亡也没有显著差异73.3%对64.5%,在分离出曲霉菌的患者中,抗真菌治疗(p=0.035,OR 12.3,CI 1.74-252);血管升压药(0.016,OR 10.6,CI 1.75-81.8);mSOFA评分越高(p=0.043或1.29 CI 1.03-1.72)与预后越差相关。在一个调整其他显著变量的多变量模型中,FiO2是分离出曲霉菌的患者中唯一与住院死亡率相关的变量(OR 1.07,95%CI 1.01-1.27)。结论:从新冠肺炎危重患者的下呼吸道样本中分离曲霉菌与高死亡率相关。新冠肺炎危重患者的叠加感染(如CAPA)阈值较低是很重要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Advances in respiratory medicine
Advances in respiratory medicine RESPIRATORY SYSTEM-
CiteScore
2.60
自引率
0.00%
发文量
90
期刊介绍: "Advances in Respiratory Medicine" is a new international title for "Pneumonologia i Alergologia Polska", edited bimonthly and addressed to respiratory professionals. The Journal contains peer-reviewed original research papers, short communications, case-reports, recommendations of the Polish Respiratory Society concerning the diagnosis and treatment of lung diseases, editorials, postgraduate education articles, letters and book reviews in the field of pneumonology, allergology, oncology, immunology and infectious diseases. "Advances in Respiratory Medicine" is an open access, official journal of Polish Society of Lung Diseases, Polish Society of Allergology and National Research Institute of Tuberculosis and Lung Diseases.
期刊最新文献
Expression of Epithelial Alarmin Receptor on Innate Lymphoid Cells Type 2 in Eosinophilic Chronic Obstructive Pulmonary Disease. Utility of Raman Spectroscopy in Pulmonary Medicine. Secure and Transparent Lung and Colon Cancer Classification Using Blockchain and Microsoft Azure. Comparing the Effects of Two Surfactant Administration Methods: Minimally Invasive Surfactant Therapy (MIST) with Intubation (INSURE) in Infants with Respiratory Distress Syndrome. The Impact of Different Telerehabilitation Methods on Peripheral Muscle Strength and Aerobic Capacity in COPD Patients: A Randomized Controlled Trial.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1