Association between Pulmonary Aspergillosis and <i>Cytomegalovirus</i> Reactivation in Critically Ill COVID-19 Patients: A Prospective Observational Cohort Study
Valeria Caciagli,
Irene Coloretti,
Marta Talamonti,
Carlotta Farinelli,
Ilenia Gatto,
Emanuela Biagioni,
Mario Sarti,
Erica Franceschini,
Marianna Meschiari,
Cristina Mussini,
Roberto Tonelli,
Enrico Clini,
Massimo Girardis,
Stefano Busani,
Modena COVID-19 Working Group
Affiliations
Valeria Caciagli
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Irene Coloretti
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Marta Talamonti
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Carlotta Farinelli
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Ilenia Gatto
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Emanuela Biagioni
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Mario Sarti
Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy
Erica Franceschini
Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Marianna Meschiari
Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Cristina Mussini
Infectious Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Roberto Tonelli
Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Enrico Clini
Respiratory Diseases Unit, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Massimo Girardis
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
Stefano Busani
Anesthesia and Intensive Care Medicine, Policlinico di Modena, University of Modena and Reggio Emilia, 41124 Modena, Italy
COVID-19-associated invasive pulmonary aspergillosis (CAPA) is common and is associated with poor outcomes in critically ill patients. This prospective observational study aimed to explore the association between CAPA development and the incidence and prognosis of cytomegalovirus (CMV) reactivation in critically ill COVID-19 patients. We included all consecutive critically ill adult patients with confirmed COVID-19 infection who were admitted to three COVID-19 intensive care units (ICUs) in an Italian hospital from 25 February 2020 to 8 May 2022. A standardized procedure was employed for early detection of CAPA. Risk factors associated with CAPA and CMV reactivation and the association between CMV recurrence and mortality were estimated using adjusted Cox proportional hazard regression models. CAPA occurred in 96 patients (16.6%) of the 579 patients analyzed. Among the CAPA population, 40 (41.7%) patients developed CMV blood reactivation with a median time of 18 days (IQR 7–27). The CAPA+CMV group did not exhibit a significantly higher 90-day mortality rate (62.5% vs. 48.2%) than the CAPA alone group (p = 0.166). The CAPA+CMV group had a longer ICU stay, fewer ventilation-free days, and a higher rate of secondary bacterial infections than the control group of CAPA alone. In the CAPA population, prior immunosuppression was the only independent risk factor for CMV reactivation (HR 2.33, 95% C.I. 1.21–4.48, p = 0.011). In critically ill COVID-19 patients, CMV reactivation is common in those with a previous CAPA diagnosis. Basal immunosuppression before COVID-19 appeared to be the primary independent variable affecting CMV reactivation in patients with CAPA. Furthermore, the association of CAPA+CMV versus CAPA alone appears to impact ICU length of stay and secondary bacterial infections but not mortality.
