COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave
Stéphane Bretagne, Karine Sitbon, Françoise Botterel, Sarah Dellière, Valérie Letscher‐Bru, Taïeb Chouaki, Anne‐Pauline Bellanger, Christine Bonnal, Arnault Fekkar, Florence Persat, Damien Costa, Nathalie Bourgeois, Frédéric Dalle, Florian Lussac‐Sorton, A. Paugam, Sophie Cassaing, Lilia Hasseine, A Huguenin, Nadia Guennouni, Edith Mazars, Solène Le Gal, Milène Sasso, Sophie Brun, Lucile Cadot, Carole Cassagne, Estelle Cateau, Jean‐Pierre Gangneux, Maxime Moniot, Anne‐Laure Roux, Céline Tournus, Nicole Desbois-Nogard, Alain Le Coustumier, Olivier Moquet, Alexandre Alanio, Françoise Dromer
Abstract
To diagnose fungal coinfections in patients with COVID-19 in the intensive care unit, it is necessary to implement the correct treatment and to prevent them if possible. For COVID-19-associated pulmonary aspergillosis (CAPA), respiratory specimens remain the best approach since serum biomarkers are rarely positive. Timing of occurrence suggests that CAPA could be hospital acquired. The associated mortality varies from 36.6% to 76.7% when no host factors or host factors of invasive fungal diseases are present, respectively. Fungemias occurred after 2 weeks in ICUs and are associated with a mortality rate of 45.7%. Candida albicans is the first yeast species recovered, with no specificity linked to COVID-19. Pneumocystosis was mainly found in patients with known immunodepression. The diagnosis occurred at the entry in ICUs and not afterwards, suggesting that if Pneumocystis jirovecii plays a role, it is upstream of the hospitalization in the ICU.