Abstract：
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) raises concerns as to whether it contributes to an increased mortality. The incidence of CAPA varies widely within hospitals and countries, partly because of difficulties in obtaining a reliable diagnosis. We implemented a routine screening of respiratory specimens in COVID-19 ICU patients for Aspergillus species using culture and galactomannan (GM) detection from serum and/or bronchoalveolar lavages (BAL). Out of 329 ICU patients treated during March 2020 and April 2021, 23 (7%) suffered from CAPA, 13 of probable, and 10 of possible. In the majority of cases, culture, microscopy, and GM testing were in accordance with CAPA definition. However, we saw that the current definitions underscore to pay attention for fungal microscopy and GM detection in BALs, categorizing definitive CAPA diagnosis based on culture positive samples only. The spectrum of Aspergillus species involved Aspergillus fumigatus, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus nidulans. We noticed changes in fungal epidemiology, but antifungal resistance was not an issue in our cohort. The study highlights that the diagnosis and incidence of CAPA is influenced by the application of laboratory-based diagnostic tests. Culture positivity as a single microbiological marker for probable definitions may overestimate CAPA cases and thus may trigger unnecessary antifungal treatment.
摘要：
2019年冠状病毒病（COVID-19）相关的肺曲霉病（CAPA）引起了人们对其是否导致死亡率增加的担忧。CAPA的发病率在医院和国家之间差异很大，部分原因是难以获得可靠的诊断。我们使用血清和/或支气管肺泡灌洗（BAL）中的培养和半乳甘露聚糖（GM）检测，对COVID-19ICU患者的呼吸道标本进行了曲霉菌属的常规筛查。在2020年3月和2021年4月期间接受治疗的329名ICU患者中，有23名（7%）患有CAPA，13的可能性，10个可能在大多数情况下,文化,显微镜,和GM测试符合CAPA定义。然而,我们看到，目前的定义强调要注意BAL中的真菌显微镜和转基因检测，仅根据培养阳性样本对明确的CAPA诊断进行分类。曲霉属的种类涉及烟曲霉，其次是黄曲霉,黑曲霉,和构巢曲霉.我们注意到真菌流行病学的变化，但抗真菌耐药性不是我们队列中的问题.该研究强调，CAPA的诊断和发病率受到基于实验室的诊断测试的应用的影响。作为可能定义的单一微生物标记的培养阳性可能会高估CAPA病例，因此可能会引发不必要的抗真菌治疗。
