ISSN: 2332-0877

Journal of Infectious Diseases & Therapy
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  • Research Article   
  • J Infect Dis Ther,

Incidence and Outcomes of Invasive Pulmonary Aspergillosis in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis

Saikat Mitra1*, Ryan Ruiyang Ling2, Sajeev Arvind Mahendran3, Megan Ruien Ling2, Ashwin Subramaniam4,5, Kiran Shekar6,7,8,9, Chuen Seng Tan10, Suei Nee Wong2, Jyoti Somani2,10, Graeme MacLaren1,2 and Kollengode Ramanathan1,2,9
1Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Lower Kent Ridge Rd, Queenstown, Singapore
2Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
3Department of Intensive Care Medicine, Royal North Shore Hospital, New South Wales, Australia
4Department of Intensive Care Medicine, Peninsula Health, Frankston, Victoria, Australia
5Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
6Adult Intensive Care Services, Prince Charles Hospital, Brisbane, Queensland, Australia
7Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
8Department of Intensive Care Medicine, University of Queensland, Brisbane, Australia
9Department of Cardiothoracic Intensive Care Unit, Bond University, Gold Coast, Queensland, Australia
10Department of Critical Care, Saw Swee Hock School of Public Health, National University of Singapore, Lower Kent Ridge Rd, Queenstown, Singapore
*Corresponding Author : Saikat Mitra, Cardiothoracic Intensive Care Unit, National University Heart Centre, Lower Kent Ridge Rd, Singapore, Email: smsaikatmitra1@gmail.com

Received Date: Mar 16, 2022 / Published Date: Apr 18, 2022

Abstract

Background: Recent reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have raised concerns about fungal super-infections in critically ill patients with COVID-19. However, true incidence of CAPA is difficult to estimate given the challenges of diagnosing invasive pulmonary aspergillosis as well as the heterogeneity in case definitions.

Methods: We conducted a systematic review of literature (through 31st December 2021) for relevant studies reporting on the CAPA incidence in critically ill COVID-19 patients. Random effects meta-analyses were conducted. Risk of bias and certainty of evidence were assessed using the appropriate Joanna Briggs Institute checklists and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach respectively. The primary outcome was the overall incidence of CAPA. Secondary outcomes included CAPA-associated mortality, ICU length of stay, duration of invasive mechanical ventilation, and the time between COVID-19 symptoms and CAPA diagnosis.

Results: Of 53 observational studies (11,013 adult COVID-19 patients), 1097 patients had CAPA; the pooled incidence of CAPA was 13.0% (95%-CI: 8.7%-18.0%), albeit with publication bias (pegger=0.002) and the pooled mortality was 63.4% (95%-CI: 56.2%-70.4%). Patients with CAPA were older (+3.1 years (95%-CI: 1.3-4.9, p=0.0006) with significantly increased mortality (Risk Ratio: 2.13 (95%- CI: 1.80-2.52, p<0.0001) compared to COVID-19 patients without CAPA. Meta-regression analysis found that corticosteroids and/or hypertension were potential risk factors for CAPA

Conclusion: Critically ill patients with COVID-19 are vulnerable to develop CAPA with considerably high mortality rates; patients with hypertension and those treated with corticosteroids as an adjuvant therapy appear to be at higher risk of CAPA.

Keywords: COVID-19; Associated pulmonary aspergillosis; Incidence; Mortality; IL-6 antagonists; Corticosteroids

Citation: Mitra S, Ling RR, Mahendran SA , Ling RM, Subramaniam A, et al. (2022) Incidence and Outcomes of Invasive Pulmonary Aspergillosis in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis. J Infect Dis Ther S2:001.

Copyright: © 2022 Mitra S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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