Invasive fungal infections in critically ill COVID-19 patients in a large tertiary university hospital in Israel

Oshrat Ayalon; Matan J Cohen; Efrat Orenbuch-Harroch; Sigal Sviri; Peter Vernon van Heerden; Maya Korem

doi:10.1016/j.jcrc.2022.154004

Invasive fungal infections in critically ill COVID-19 patients in a large tertiary university hospital in Israel

J Crit Care. 2022 Jun:69:154004. doi: 10.1016/j.jcrc.2022.154004. Epub 2022 Feb 10.

Authors

Oshrat Ayalon¹, Matan J Cohen², Efrat Orenbuch-Harroch³, Sigal Sviri⁴, Peter Vernon van Heerden⁵, Maya Korem⁶

Affiliations

¹ Faculty of Medicine, Hebrew University of Jerusalem, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel.
² Clalit Health Services, Jerusalem District, affiliated with the Hebrew University Hadassah Medical School, Jerusalem, Israel.
³ Faculty of Medicine, Hebrew University of Jerusalem, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.
⁴ Faculty of Medicine, Hebrew University of Jerusalem, Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.
⁵ Faculty of Medicine, Hebrew University of Jerusalem, General Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.
⁶ Faculty of Medicine, Hebrew University of Jerusalem, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Jerusalem, Israel. Electronic address: mayak@hadassah.org.il.

Abstract

An increasing number of studies have tried to determine the incidence of invasive fungal infections (IFIs) in COVID-19 patients. Challenges in the diagnosis of pulmonary aspergillosis in these patients have led to new definitions of COVID-19-associated pulmonary aspergillosis (CAPA). The aim of this study was to determine the incidence and outcomes of and risk factors for IFIs in critically-ill COVID-19 patients, using the new definitions, in a tertiary center in Israel.

Methods: A case-controlled study (from 1 September 2020 to 31 March 2021) in which data from COVID-19 critically-ill patients with a diagnosis of IFI were collected and compared to a control group without IFI.

Results: The incidence of IFI amongst 311 COVID-19 critically-ill patients was 6.1%. 3.5% had CAPA and 3.5% had candidemia. In-hospital mortality was higher amongst patients with IFI compared to those without IFI (89.4% vs 60%, p < 0.03). The most significant predictors of IFI were cardiovascular co-morbidity and carbapenem use.

Conclusions: The low incidence of CAPA in our group of COVID-19 critically-ill patients was consistent with recent reports, underscoring the importance of differentiating between true infection and colonization. Awareness and timely diagnosis of IFIs in COVID-19 critically-ill patients are imperative considering the associated high mortality.

Keywords: Aspergillosis; COVID-19; Candidemia; Intensive care unit; Invasive fungal infection.

MeSH terms

COVID-19*
Critical Illness
Humans
Invasive Fungal Infections* / diagnosis
Invasive Fungal Infections* / drug therapy
Invasive Fungal Infections* / epidemiology
Israel / epidemiology
Pulmonary Aspergillosis*
Tertiary Care Centers