TY - JOUR
T1 - Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia
T2 - a European multicenter comparative cohort study
AU - the coVAPid study group
AU - Rouzé, Anahita
AU - Lemaitre, Elise
AU - Martin-Loeches, Ignacio
AU - Povoa, Pedro
AU - Diaz, Emili
AU - Nyga, Rémy
AU - Torres, Antoni
AU - Metzelard, Matthieu
AU - Du Cheyron, Damien
AU - Lambiotte, Fabien
AU - Tamion, Fabienne
AU - Labruyere, Marie
AU - Boulle Geronimi, Claire
AU - Luyt, Charles Edouard
AU - Nyunga, Martine
AU - Pouly, Olivier
AU - Thille, Arnaud W.
AU - Megarbane, Bruno
AU - Saade, Anastasia
AU - Magira, Eleni
AU - Llitjos, Jean François
AU - Ioannidou, Iliana
AU - Pierre, Alexandre
AU - Reignier, Jean
AU - Garot, Denis
AU - Kreitmann, Louis
AU - Baudel, Jean Luc
AU - Voiriot, Guillaume
AU - Plantefeve, Gaëtan
AU - Morawiec, Elise
AU - Asfar, Pierre
AU - Boyer, Alexandre
AU - Mekontso-Dessap, Armand
AU - Makris, Demosthenes
AU - Vinsonneau, Christophe
AU - Floch, Pierre Edouard
AU - Marois, Clémence
AU - Ceccato, Adrian
AU - Artigas, Antonio
AU - Gaudet, Alexandre
AU - Nora, David
AU - Cornu, Marjorie
AU - Duhamel, Alain
AU - Labreuche, Julien
AU - Nseir, Saad
AU - Bouchereau, Mathilde
AU - Sendid, Boualem
AU - Boyd, Sean
AU - Coelho, Luis
AU - Cilloniz, Catia
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. Objectives: To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. Methods: This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. Results: A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. Conclusions: Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.
AB - Background: Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. Objectives: To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. Methods: This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. Results: A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. Conclusions: Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693.
KW - COVID-19
KW - Intensive care unit
KW - Invasive pulmonary aspergillosis
KW - Mechanical ventilation
KW - Severe influenza
UR - http://www.scopus.com/inward/record.url?scp=85122459229&partnerID=8YFLogxK
U2 - 10.1186/s13054-021-03874-1
DO - 10.1186/s13054-021-03874-1
M3 - Original Article
C2 - 34983611
AN - SCOPUS:85122459229
SN - 1364-8535
VL - 26
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 11
ER -