背景:呼吸道病毒引起的损害增加了细菌和真菌合并感染和重叠感染的风险。在严重的流感和COVID-19中可见高发病率的侵袭性曲霉病。本报告描述了墨西哥最大的严重COVID-19参考中心在第一波中诊断出的CAPA病例。
目的:描述临床,与重症COVID-19相关的侵袭性肺曲霉病患者的微生物学和放射学特征,以及描述与死亡率相关的变量。
方法:这项回顾性研究确定了COVID-19和ARDS患者的CAPA病例,从2020年3月1日至2021年3月31日住院。CAPA是根据ECMM/ISHAM共识标准定义的。患病率估计。临床和微生物学特征,包括细菌超感染,记录抗真菌药敏试验和结果.
结果:在2080例严重COVID-19患者中,86例患者被诊断出可能的CAPA,占4.13%的患病率。所有CAPA病例的曲霉属呼吸道培养均为阳性。烟曲霉是最常见的分离株(64%,n=55/86)。七个分离株(9%,n=7/80)对两性霉素B(A.烟曲霉n=5/55,9%;黑曲霉,n=2/7,28%),两种烟曲霉分离株对伊曲康唑耐药(3.6%,n=2/55)。气管半乳甘露聚糖值在1.2至4.05之间,而血清半乳甘露聚糖仅在11%(n=3/26)中呈阳性。46%的细菌合并感染(n=40/86)。革兰氏阴性是最常见的原因(77%,n=31/40分离株),其中13%(n=4/31)被报告为多重耐药细菌。死亡率为60%,老年人预后较差,高气管半乳甘露聚糖指数和高HbA1c水平。
结论:每10个CAPA患者中就有1个携带耐药曲霉分离物和/或将受到MDR细菌的影响。在这个人群中看到了高死亡率。
BACKGROUND: Damage due to respiratory viruses increases the risk of bacterial and fungal coinfections and superinfections. High rates of invasive aspergillosis are seen in severe influenza and COVID-19. This report describes CAPA cases diagnosed during the first wave in the biggest reference centre for severe COVID-19 in Mexico.
OBJECTIVE: To describe the clinical, microbiological and radiological characteristics of patients with invasive pulmonary aspergillosis associated with critical COVID-19, as well as to describe the variables associated with mortality.
METHODS: This retrospective study identified CAPA cases among individuals with COVID-19 and ARDS, hospitalised from 1 March 2020 to 31 March 2021. CAPA was defined according to ECMM/ISHAM consensus criteria. Prevalence was estimated. Clinical and microbiological characteristics including bacterial superinfections, antifungal susceptibility testing and outcomes were documented.
RESULTS: Possible CAPA was diagnosed in 86 patients among 2080 individuals with severe COVID-19, representing 4.13% prevalence. All CAPA cases had a positive respiratory culture for Aspergillus species. Aspergillus fumigatus was the most frequent isolate (64%, n = 55/86). Seven isolates (9%, n = 7/80) were resistant to amphotericin B (A. fumigatus n = 5/55, 9%; A. niger, n = 2/7, 28%), two A. fumigatus isolates were resistant to itraconazole (3.6%, n = 2/55). Tracheal galactomannan values ranged between 1.2 and 4.05, while serum galactomannan was positive only in 11% (n = 3/26). Bacterial coinfection were documented in 46% (n = 40/86). Gram negatives were the most frequent cause (77%, n = 31/40 isolates), from which 13% (n = 4/31) were reported as multidrug-resistant bacteria. Mortality rate was 60% and worse prognosis was seen in older persons, high tracheal galactomannan index and high HbA1c level.
CONCLUSIONS: One in 10 individuals with CAPA carry a resistant Aspergillus isolate and/or will be affected by a MDR bacteria. High mortality rates are seen in this population.