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SHR Neuro Krebs Kardio Lipid Stoffw Microb

Hatzl, S; Reisinger, AC; Posch, F; Prattes, J; Stradner, M; Pilz, S; Eller, P; Schoerghuber, M; Toller, W; Gorkiewicz, G; Metnitz, P; Rief, M; Prüller, F; Rosenkranz, AR; Valentin, T; Krause, R; Hoenigl, M; Schilcher, G.
Antifungal prophylaxis for prevention of COVID-19-associated pulmonary aspergillosis in critically ill patients: an observational study.
Crit Care. 2021; 25(1): 335 Doi: 10.1186/s13054-021-03753-9 [OPEN ACCESS]
Web of Science PubMed PUBMED Central FullText FullText_MUG

 

Führende Autor*innen der Med Uni Graz
Hatzl Stefan
Krause Robert
Reisinger Alexander Christian
Co-Autor*innen der Med Uni Graz
Eller Philipp
Gorkiewicz Gregor
Hönigl Martin
Metnitz Philipp
Pilz Stefan
Posch Florian
Prattes Jürgen
Prüller Florian
Rief Martin
Rosenkranz Alexander
Schilcher Gernot
Schörghuber Michael
Stradner Martin Helmut
Toller Wolfgang
Valentin Thomas
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Abstract:
BACKGROUND: Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) emerged as important fungal complications in patients with COVID-19-associated severe acute respiratory failure (ARF). Whether mould active antifungal prophylaxis (MAFP) can prevent CAPA remains elusive so far. METHODS: In this observational study, we included all consecutive patients admitted to intensive care units with COVID-19-associated ARF between September 1, 2020, and May 1, 2021. We compared patients with versus without antifungal prophylaxis with respect to CAPA incidence (primary outcome) and mortality (secondary outcome). Propensity score adjustment was performed to account for any imbalances in baseline characteristics. CAPA cases were classified according to European Confederation of Medical Mycology (ECMM)/International Society of Human and Animal Mycoses (ISHAM) consensus criteria. RESULTS: We included 132 patients, of whom 75 (57%) received antifungal prophylaxis (98% posaconazole). Ten CAPA cases were diagnosed, after a median of 6 days following ICU admission. Of those, 9 CAPA cases were recorded in the non-prophylaxis group and one in the prophylaxis group, respectively. However, no difference in 30-day ICU mortality could be observed. Thirty-day CAPA incidence estimates were 1.4% (95% CI 0.2-9.7) in the MAFP group and 17.5% (95% CI 9.6-31.4) in the group without MAFP (p = 0.002). The respective subdistributional hazard ratio (sHR) for CAPA incidence comparing the MAFP versus no MAFP group was of 0.08 (95% CI 0.01-0.63; p = 0.017). CONCLUSION: In ICU patients with COVID-19 ARF, antifungal prophylaxis was associated with significantly reduced CAPA incidence, but this did not translate into improved survival. Randomized controlled trials are warranted to evaluate the efficacy and safety of MAFP with respect to CAPA incidence and clinical outcomes.

Find related publications in this database (Keywords)
ICU
CAPA
COVID-19-associated aspergillosis
Posaconazole
Mould prophylaxis
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