COVID-19-associated Pulmonary Aspergillosis in Mechanically Ventilated Patients at 7 US Hospitals: Epidemiology and Estimated Likelihood of Invasive Pulmonary Aspergillosis—Results of the Prospective MSG-017 Study - Summary - MDSpire
Advertisement
COVID-19-associated Pulmonary Aspergillosis in Mechanically Ventilated Patients at 7 US Hospitals: Epidemiology and Estimated Likelihood of Invasive Pulmonary Aspergillosis—Results of the Prospective MSG-017 Study
To determine the epidemiology, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) in US intensive care units (ICUs) and estimate the likelihood of invasive pulmonary aspergillosis (IPA) among patients diagnosed with CAPA, while clarifying the distinction between CAPA and IPA.
Key Findings:
CAPA incidence was 7% (14/212) among mechanically ventilated COVID-19 patients, indicating a significant prevalence.
Independent risk factors for CAPA included EORTC/MSGERC host factors and cavitary lesions, which are critical for understanding patient risk profiles.
Mortality rate for CAPA was 71%, with no significant difference in mortality with antifungal treatment, suggesting treatment may not impact outcomes.
CAPA definitions resulted in varying IPA likelihood estimates, with a median likelihood of 30%, highlighting the need for standardized definitions.
Interpretation:
CAPA is associated with high mortality in mechanically ventilated COVID-19 patients, but the contribution of IPA to mortality remains unclear; single positive tests for Aspergillus are insufficient for diagnosing IPA, necessitating a combination of test results for accurate assessment.
Limitations:
Lack of universally accepted diagnostic criteria for CAPA limits the ability to compare findings across studies.
Potential for false-positive results in severe COVID-19 patients complicates the diagnosis of IPA.
Limited generalizability due to the study's multicenter design and specific patient population, which may not reflect broader trends.
Conclusion:
CAPA presents a significant risk in mechanically ventilated COVID-19 patients, highlighting the need for improved diagnostic criteria and understanding of its clinical implications.
by M Hong Nguyen, Sixto M Leal, Luis Ostrosky-Zeichner, Andrej Spec, George R Thompson, Thomas F Patterson, John Baddley, Rachel McMullen, Drashti Shah, Cornelius J Clancy, Gerald McGwin, Peter G Pappas
Invited narrative review supports early, interprofessional rehabilitation across the ICU recovery continuum while emphasizing heterogeneous evidence and inconsistent implementation worldwide.
