Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study.
COVID-19
Intensive care unit
Invasive pulmonary aspergillosis
Mechanical ventilation
Severe influenza
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
04 01 2022
04 01 2022
Historique:
received:
22
10
2021
accepted:
17
12
2021
entrez:
5
1
2022
pubmed:
6
1
2022
medline:
11
1
2022
Statut:
epublish
Résumé
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. To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. 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. 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. 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 .
Sections du résumé
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 .
Identifiants
pubmed: 34983611
doi: 10.1186/s13054-021-03874-1
pii: 10.1186/s13054-021-03874-1
pmc: PMC8724752
doi:
Banques de données
ClinicalTrials.gov
['NCT04359693']
Types de publication
Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
11Investigateurs
Mathilde Bouchereau
(M)
Boualem Sendid
(B)
Sean Boyd
(S)
Luis Coelho
(L)
Julien Maizel
(J)
Pierre Cuchet
(P)
Wafa Zarrougui
(W)
Déborah Boyer
(D)
Jean-Pierre Quenot
(JP)
Mehdi Imouloudene
(M)
Marc Pineton de Chambrun
(MP)
Thierry Van Der Linden
(T)
François Arrive
(F)
Sebastian Voicu
(S)
Elie Azoulay
(E)
Edgard Moglia
(E)
Frédéric Pene
(F)
Catia Cilloniz
(C)
Didier Thevenin
(D)
Charlotte Larrat
(C)
Laurent Argaud
(L)
Bertrand Guidet
(B)
Matthieu Turpin
(M)
Damien Contou
(D)
Alexandra Beurton
(A)
Julien Demiselle
(J)
David Meguerditchian
(D)
Keyvan Razazi
(K)
Romain Arrestier
(R)
Vassiliki Tsolaki
(V)
Mehdi Marzouk
(M)
Guillaume Brunin
(G)
Nicolas Weiss
(N)
Luis Morales
(L)
Informations de copyright
© 2022. The Author(s).
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