Annals of Intensive Care (Apr 2024)

COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants

  • Pierre Bay,
  • Etienne Audureau,
  • Sébastien Préau,
  • Raphaël Favory,
  • Aurélie Guigon,
  • Nicholas Heming,
  • Elyanne Gault,
  • Tài Pham,
  • Amal Chaghouri,
  • Matthieu Turpin,
  • Laurence Morand-Joubert,
  • Sébastien Jochmans,
  • Aurélia Pitsch,
  • Sylvie Meireles,
  • Damien Contou,
  • Amandine Henry,
  • Adrien Joseph,
  • Marie-Laure Chaix,
  • Fabrice Uhel,
  • Damien Roux,
  • Diane Descamps,
  • Malo Emery,
  • Claudio Garcia-Sanchez,
  • David Levy,
  • Sonia Burrel,
  • Julien Mayaux,
  • Antoine Kimmoun,
  • Cédric Hartard,
  • Frédéric Pène,
  • Flore Rozenberg,
  • Stéphane Gaudry,
  • Ségolène Brichler,
  • Antoine Guillon,
  • Lynda Handala,
  • Fabienne Tamion,
  • Alice Moisan,
  • Thomas Daix,
  • Sébastien Hantz,
  • Flora Delamaire,
  • Vincent Thibault,
  • Bertrand Souweine,
  • Cecile Henquell,
  • Lucile Picard,
  • Françoise Botterel,
  • Christophe Rodriguez,
  • Armand Mekontso Dessap,
  • Jean-Michel Pawlotsky,
  • Slim Fourati,
  • Nicolas de Prost,
  • the SEVARVIR investigators

DOI
https://doi.org/10.1186/s13613-024-01296-0
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 12

Abstract

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Abstract Background During the first COVID-19 pandemic wave, COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in up to 11–28% of critically ill COVID-19 patients and associated with increased mortality. As new SARS-CoV-2 variants emerged, the characteristics of critically ill COVID-19 patients have evolved, particularly in the era of Omicron. The purpose of this study is to investigate the characteristics of CAPA in the era of new variants. Methods This is a prospective multicenter observational cohort study conducted in France in 36 participating intensive care units (ICU), between December 7th, 2021 and April 26th 2023. Diagnosis criteria of CAPA relied on European Confederation of Medical Mycology (ECMM)/International Society for Human & Animal Mycology (ISHAM) consensus criteria. Results 566 patients were included over the study period. The prevalence of CAPA was 5.1% [95% CI 3.4–7.3], and rose to 9.1% among patients who required invasive mechanical ventilation (IMV). Univariable analysis showed that CAPA patients were more frequently immunosuppressed and required more frequently IMV support, vasopressors and renal replacement therapy during ICU stay than non-CAPA patients. SAPS II score at ICU admission, immunosuppression, and a SARS-CoV-2 Delta variant were independently associated with CAPA in multivariable logistic regression analysis. Although CAPA was not significantly associated with day-28 mortality, patients with CAPA experienced a longer duration of mechanical ventilation and ICU stay. Conclusion This study contributes valuable insights into the prevalence, characteristics, and outcomes of CAPA in the era of Delta and Omicron variants. We report a lower prevalence of CAPA (5.1%) among critically-ill COVID-19 patients than previously reported, mainly affecting intubated-patients. Duration of mechanical ventilation and ICU stay were significantly longer in CAPA patients.

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