PhD Scientific Days 2021

CL_III_L: Clinical Medicine III. Lectures

Invasive fungal infections among critically ill adult COVID-19 patients: first experiences from the national centre in Hungary

Text of the abstract

Introduction
Data suggests that invasive fungal infections (IFI) might complicate COVID-19.

Aim
Our goal was to describe characteristics of IFI among critically ill COVID-19 adults.

Methods
A retrospective observational case-series analysis was done between March–July 2020. Consecutive patients with critical COVID-19 were eligible, and have been included when proven or putative/probable IFI could be confirmed during their course. For COVID-19 diagnosis, ECDC definitions and WHO severity criteria were followed. Candidaemia was defined according to the ESCMID 2012 guideline. Invasive pulmonary aspergillosis (IPA) was diagnosed following EORTC/MSG and modified AspICU criteria. Outcome variables were rates of IFIs, in-hospital all-cause mortality, rate and time to negative respiratory SARS-CoV-2 PCR.

Results
From 90 eligible patients, 20 (22.2%) fulfilled criteria for IFI. Incidence rate for IFI was 2.02 per 100 patient-days at ICU. Patients were mostly elderly males with significant comorbidities, requiring mechanical ventilation because of ARDS. IFI could be classified as candidaemia in 7/20 (40%), proven IPA in 3/20 (15.0%), putative IPA in 13/20 (65.0%). Isolated species of candidaemia episodes were Candida albicans (4/9, 44.4%), Candida glabrata (3/9, 33.3%), Candida parapsilosis (1/9, 11.1%), Candida metapsilosis (1/9, 11.1%). Mold isolates were Aspergillus fumigatus, BAL galactomannan positivity was prevalent (16/20, 80.0%). Mortality was 12/20 (60.0%) with a median time to death of 31.0±37.0 (5–89) days. Only 9/20 (45.0%) patients reached SARS-CoV-2 PCR negativity after a median time of 20.0±12.0 (3–38) days.

Conclusion
In this small cohort of critically ill COVID-19 adults, morbidity and mortality related to invasive fungal infections proved to be significant.

Funding
The article itself did not receive any external funding. BGSz received the EFOP-3.6.3-VEKOP-16-2017-00009 Doctorate Grant, and was supported by the ÚNKP-19-3-I-SE-74 New National Excellence Program of the Ministry of Innovation and Technology of Hungary. The funding sources had no involvement in the preparation, writing, interpretation, or submission of this article.

University and Doctoral School

Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine