The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients

Heba Osman; Asra N Shaik; Paul L Nguyen; Zachary Cantor; Mirna Kaafarani; Ayman O Soubani

doi:10.3390/arm91050027

The Clinical Significance of Aspergillus Detected in Lower-Respiratory-Tract Samples of Critically Ill COVID-19-Positive Patients

Adv Respir Med. 2023 Sep 2;91(5):337-349. doi: 10.3390/arm91050027.

Authors

Heba Osman¹, Asra N Shaik², Paul L Nguyen², Zachary Cantor², Mirna Kaafarani³, Ayman O Soubani³

Affiliations

¹ Department of Medicine and Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA.
² Department of Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
³ Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, 3990 John R-3 Hudson, Detroit, MI 48201, USA.

Abstract

Objective: Critically ill patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications, including invasive aspergillosis. Our study aimed to characterize the clinical significance and outcome of Aspergillus species isolated from lower-respiratory-tract samples of critically ill OVID-19 patients at a single center. Design: We conducted a retrospective cohort study to evaluate the characteristics of patients with COVID-19 and aspergillus isolated from the lower respiratory tract and to identify predictors of outcomes in this population. Setting: The setting was a single-center hospital system within the metropolitan Detroit region. Results: The prevalence of Aspergillus isolated in hospitalized COVID-19 patients was 1.18% (30/2461 patients), and it was 4.6% in critically ill ICU patients with COVID-19. Probable COVID-19-associated invasive pulmonary aspergillosis (CAPA) was found in 21 critically ill patients, and 9 cases were classified as colonization. The in-hospital mortality of critically ill patients with CAPA and those with aspergillus colonization were high but not significantly different (76% vs. 67%, p = 1.00). Furthermore, the in-hospital mortality for ICU patients with or without Aspergillus isolated was not significantly different 73.3% vs. 64.5%, respectively (OR 1.53, CI 0.64-4.06, p = 0.43). In patients in whom Aspergillus was isolated, antifungal therapy (p = 0.035, OR 12.3, CI 1.74-252); vasopressors (0.016, OR 10.6, CI 1.75-81.8); and a higher mSOFA score (p = 0.043, OR 1.29 CI 1.03-1.72) were associated with a worse outcome. In a multivariable model adjusting for other significant variables, FiO₂ was the only variable associated with in-hospital mortality in patients in whom Aspergillus was isolated (OR 1.07, 95% CI 1.01-1.27). Conclusions: The isolation of Aspergillus from lower-respiratory-tract samples of critically ill patients with COVID-19 is associated with high mortality. It is important to have a low threshold for superimposed infections such as CAPA in critically ill patients with COVID-19.

Keywords: Aspergillus; COVID-19; SARS-CoV-2; invasive pulmonary aspergillosis; superimposed infection.

MeSH terms

Aspergillus
COVID-19* / epidemiology
Clinical Relevance
Critical Illness
Humans
Invasive Pulmonary Aspergillosis* / diagnosis
Retrospective Studies

Grants and funding

This research received no external funding.