Prospective and systematic screening for invasive aspergillosis in the ICU during the COVID-19 pandemic, a proof of principle for future pandemics

The diagnostic performance of a prospective, systematic screening strategy for COVID-19 associated pulmonary aspergillosis (CAPA) during the COVID-19 pandemic was investigated. Patients with COVID-19 admitted to the ICU were screened for CAPA twice weekly by collection of tracheal aspirate (TA) for...

Full description

Saved in:
Bibliographic Details
Published in:Medical mycology (Oxford) 2024-05, Vol.62 (5)
Main Authors: van Grootveld, Rebecca, van Paassen, Judith, Claas, Eric C J, Heerdink, Laura, Kuijper, Ed J, de Boer, Mark G J, van der Beek, Martha T
Format: Article
Language:English
Subjects:
Adult
Aged
Aspergillus - isolation & purification
Bronchoalveolar Lavage Fluid - microbiology
COVID-19 - diagnosis
COVID-19 - epidemiology
Female
Humans
Intensive Care Units - statistics & numerical data
Invasive Pulmonary Aspergillosis - diagnosis
Invasive Pulmonary Aspergillosis - epidemiology
Male
Mass Screening - methods
Middle Aged
Original
Prospective Studies
SARS-CoV-2 - genetics
SARS-CoV-2 - isolation & purification
Sensitivity and Specificity
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The diagnostic performance of a prospective, systematic screening strategy for COVID-19 associated pulmonary aspergillosis (CAPA) during the COVID-19 pandemic was investigated. Patients with COVID-19 admitted to the ICU were screened for CAPA twice weekly by collection of tracheal aspirate (TA) for Aspergillus culture and PCR. Subsequently, bronchoalveolar lavage (BAL) sampling was performed in patients with positive screening results and clinical suspicion of infection. Patient data were collected from April 2020-February 2022. Patients were classified according to 2020 ECMM/ISHAM consensus criteria. In total, 126/370 (34%) patients were positive in screening and CAPA frequency was 52/370 (14%) (including 13 patients negative in screening). CAPA was confirmed in 32/43 (74%) screening positive patients who underwent BAL sampling. ICU mortality was 62% in patients with positive screening and confirmed CAPA, and 31% in CAPA cases who were screening negative. The sensitivity, specificity, positive and negative predictive value (PPV & NPV) of screening for CAPA were 0.71, 0.73, 0.27, and 0.95, respectively. The PPV was higher if screening was culture positive compared to PCR positive only, 0.42 and 0.12 respectively. CAPA was confirmed in 74% of screening positive patients, and culture of TA had a better diagnostic performance than PCR. Positive screening along with clinical manifestations appeared to be a good indication for BAL sampling since diagnosis of CAPA was confirmed in most of these patients. Prospective, systematic screening allowed to quickly gain insight into the epidemiology of fungal superinfections during the pandemic and could be applicable for future pandemics.
ISSN:1369-3786
1460-2709
DOI:10.1093/mmy/myae028