Risk factors and the value of microbiological examinations of COVID-19 associated pulmonary aspergillosis in critically ill patients in intensive care unit: the appropriate microbiological examinations are crucial for the timely diagnosis of CAPA

Xiaoyi Zhou; Xiaojing Wu; Ziying Chen; Xiaoyang Cui; Ying Cai; Youfang Liu; Bingbing Weng; Qingyuan Zhan; Linna Huang

doi:10.3389/fcimb.2023.1287496

Risk factors and the value of microbiological examinations of COVID-19 associated pulmonary aspergillosis in critically ill patients in intensive care unit: the appropriate microbiological examinations are crucial for the timely diagnosis of CAPA

Front Cell Infect Microbiol. 2023 Nov 21:13:1287496. doi: 10.3389/fcimb.2023.1287496. eCollection 2023.

Authors

Xiaoyi Zhou^#^{1

2}, Xiaojing Wu^#², Ziying Chen^{1

2}, Xiaoyang Cui², Ying Cai², Youfang Liu^{2

3}, Bingbing Weng^{2

3}, Qingyuan Zhan^{1

2

3}, Linna Huang²

Affiliations

¹ Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
² National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
³ Bejing University of Chinese Medicine, Beijing, China.

^# Contributed equally.

Abstract

Introduction: During the Omicron pandemic in China, a significant proportion of patients with Coronavirus Disease 2019 (COVID-19) associated pulmonary aspergillosis (CAPA) necessitated admission to intensive care unit (ICU) and experienced a high mortality. To explore the clinical risk factors and the application/indication of microbiological examinations of CAPA in ICU for timely diagnosis are very important.

Methods: This prospective study included patients with COVID-19 admitted to ICU between December 1, 2022, and February 28, 2023. The clinical data of influenza-associated pulmonary aspergillosis (IAPA) patients from the past five consecutive influenza seasons (November 1, 2017, to March 31, 2022) were collected for comparison. The types of specimens and methods used for microbiological examinations were also recorded to explore the efficacy in early diagnosis.

Results: Among 123 COVID-19 patients, 36 (29.3%) were diagnosed with probable CAPA. CAPA patients were more immunosuppressed, in more serious condition, required more advanced respiratory support and had more other organ comorbidities. Solid organ transplantation, APACHEII score ≥20 points, 5 points ≤SOFA score <10 points were independent risk factors for CAPA. Qualified lower respiratory tract specimens were obtained from all patients, and 84/123 (68.3%) patients underwent bronchoscopy to obtain bronchoalveolar lavage fluid (BALF) specimens. All patients' lower respiratory tract specimens underwent fungal smear and culture; 79/123 (64.2%) and 69/123 (56.1%) patients underwent BALF galactomannan (GM) and serum GM detection, respectively; metagenomic next-generation sequencing (mNGS) of the BALF was performed in 62/123 (50.4%) patients. BALF GM had the highest diagnostic sensitivity (84.9%), the area under the curve of the mNGS were the highest (0.812).

Conclusion: The incidence of CAPA was extremely high in patients admitted to the ICU. CAPA diagnosis mainly depends on microbiological evidence owing to non-specific clinical manifestations, routine laboratory examinations, and CT findings. The bronchoscopy should be performed and the BALF should be obtained as soon as possible. BALF GM are the most suitable microbiological examinations for the diagnosis of CAPA. Due to the timely and accuracy result of mNGS, it could assist in early diagnosis and might be an option in critically ill CAPA patients.

Keywords: Coronavirus Disease 2019; influenza; intensive care unit; invasive pulmonary aspergillosis; microbiological examination; risk factors.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Bronchoalveolar Lavage Fluid / microbiology
COVID-19 Testing
COVID-19* / complications
COVID-19* / diagnosis
Critical Illness
Humans
Influenza, Human* / complications
Intensive Care Units
Invasive Pulmonary Aspergillosis* / diagnosis
Prospective Studies
Pulmonary Aspergillosis* / complications
Pulmonary Aspergillosis* / diagnosis
Risk Factors
Sensitivity and Specificity

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The funding source of the study [National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-01)] is an academic non-profit organization that played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.