Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study
Cohort study (n=565) found 15% of mechanically ventilated patients with COVID-19 had proven or probable COVID-19-associated pulmonary aspergillosis (CAPA). Age >62yrs, treatment with dexamethasone and >14 days mechanical ventilation were associated with increased risk.
Source:
The Lancet Respiratory Medicine
SPS commentary:
Authors note, at time of ICU discharge, survival curves showed that overall ICU mortality was significantly higher in patients with CAPA than in those without (61·8% vs 32·1%, p<0·0001).
A related commentary notes that the study was performed during the first wave and the epidemiology is likely to have changed. Factors that might increase invasive fungal infection frequency include the standard use of dexamethasone combined with anti-IL-6 in severe COVID-19 and emergence of new (more virulent) SARS-CoV-2 variants. They note integrated risk profiling could involve analysing markers of opportunistic pathogens, including viral loads, as well as systemic and local host parameters, including inflammatory cells and cytokines associated with inflammatory pathways, endothelial injury, and alveolar type 1 and 2 injury. Risk profiles could then be correlated with immunosuppressive treatments and outcome. Such an approach might help early identification of patients with severe COVID-19 who might benefit from tailored interventions such as pre-emptive antifungal therapy.