Journal Article

A Tale of Two Hospitals: Comparing CAPA Infections in Two ICUs During the Spanish Fourth Pandemic Wave

Sánchez-Castellano, Miguel Ángel, García-Rodríguez, Julio, Marcelo, Cristina, Figueira-Iglesias, Juan Carlos, Marco, Javier

2023

Overview

Purpose COVID-19 associated pulmonary aspergillosis (CAPA) is a new clinical entity linked to SARS-CoV-2 infection that is causing a rise on the risk of complications and mortality, particularly in critical patients. Methods We compared diagnostic and clinical features in two cohorts of patients with severe COVID-19 admitted in the intensive care units (ICU) of two different hospitals in Madrid, Spain, between February and June 2021. Clinical and microbiological relevant aspects for CAPA diagnosis were collected for further classification. CAPA was classified as colonization, possible, probable, proven, and tracheobronchial aspergillosis according to the ECMM/ISHAM consensus, with some modifications to consider tracheobronchial aspirate as sample comparable to non-bronchoscopic lavages (NBL). Results 56 patients admitted in HULP ( Hospital Universitario La Paz ) ICU and 61 patients admitted in HEEIZ ( Hospital de Emergencias Isabel Zendal ) ICU had clinical suspicion of invasive fungal disease in the context of COVID-19 infection. Cultures were positive for Aspergillus spp . in 32 patients. According to 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus, 11 patients were diagnosed with possible CAPA and 10 patients with probable CAPA. Global incidence for CAPA was 6.3%. Global median days between ICU admission and diagnosis was 14 day. Aspergillus fumigatus complex was the main isolated species. Antifungal therapy was used in 75% of patients with CAPA suspicion, with inter-hospital differences in the administered antifungals. Global overall mortality rate for CAPA patients was 66.6% (14/21). All-cause mortality in non-CAPA cohorts were of 26.3% in HULP group (34/129) and 56.8% (104/183) in HEEIZ group. Conclusions There were no significant differences in incidence between the two hospitals, and differences in antifungal therapy did not correlate with differences in mortality, reflecting that both first-line azoles and Amphotericin B could be effective in treating CAPA infections, according to the current guideline indications.

• Publisher: Springer Netherlands,Springer,Springer Nature B.V
• Subject: Amphotericin B / Antifungal agents / Aspergillosis / Azoles / Biomedical and Life Sciences / Comparative analysis / COVID-19 / Diagnosis / Eukaryotic Microbiology / Fungal infections / Health aspects / Hospitals / Infection / Intensive care units / Life Sciences / Medical Microbiology / Microbial Ecology / Microbiology / Mortality / Original / Original Article / Patients / Plant Sciences / Severe acute respiratory syndrome coronavirus 2