During the Omicron-dominant phase of the COVID-19 pandemic, infection with COVID-19-associated pulmonary aspergillosis (CAPA) was associated with increased mortality risk, according to results of a study published in BMC Infectious Diseases.
The Omicron variant has been associated with increased transmission and immune escape compared with previous COVID-19 variants. For patients with COVID-19, secondary pulmonary aspergillosis is considered to be a life-threatening infection.
To assess CAPA trends during the Omicron-dominant phase of the COVID-19 pandemic, researchers conducted a retrospective study using patient (N=4421) data collected between December 2022 and January 2023 from the Renmin Hospital of Wuhan University in China. The researchers used 1:1 propensity score matching to compare clinical characteristics and outcomes between a subset of patients with CAPA (n=168) and a subset of those without secondary fungal infection (controls; n=168).
Among patients in the CAPA and control cohorts, the median ages were 74.5 (IQR, 62.0-83.0) and 71.0 (IQR, 59.0-82.0) years; 73.8% and 70.2% were men; 23.8% and 11.9% had a history of smoking (P =.007); and 13.1% and 5.4% had a history of chronic obstructive pulmonary disease (P =.022), respectively. Patients with CAPA more commonly had severe or critical disease, both at admission (33.9% vs 28.6%) and during hospitalization (82.1% vs 42.3%; P <.001).
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The risk factors of CAPA and death obtained from the study can help us further understand the disease characteristics of CAPA and better guide our clinical decision-making.
Among patients in the CAPA group, the most common aspergillus isolate was Aspergillus fumigatus (56.40%), followed by A favus (26.74%), A niger (7.56%), and A terreus (4.65%).
Comparisons between the groups showed that patients with CAPA had significantly higher rates intensive care unit (ICU) admission (50.6% vs 13.1%; P <.001) and mortality (43.5% vs 10.1%; P <.001). Patients with CAPA also underwent significantly more invasive procedures, including indwelling urinary or central venous catheterization, puncture and drainage, mechanical ventilation, and tracheal intubation.
Receipt of immunoglobulins (P =.008), oxygen therapy (P =.001), high-and flow oxygen therapy (P <.001) was significantly more common among patients with CAPA relative to control patients, as was the use of meropenem, vancomycin, teicoplanin, imipenem, etimicin, polymyxin B, linezolid, and cephalosporin.
In a multivariate logistic regression analysis, significant risk factors for CAPA were as follows:
- Receipt of at least 3 antibiotics (odds ratio [OR], 3.926; 95% CI, 2.243-6.869; P <.001);
- Immunocompromised status (OR, 2.220; 95% CI, 1.116-4.414; P =.023);
- Higher C-reactive protein level (≥50 mg/L; OR, 2.182; 95% CI, 1.279-3.721; P =.004); and
- Higher neutrophil-lymphocyte ratio (≥5.7; OR, 1.726; 95% CI, 1.017-2.930; P =.043).
Within the CAPA group, survivors vs nonsurvivors had significantly lower neutrophil-lymphocyte ratio (median, 5.9 vs 10.4; P =.001), as well as significantly lower rates of ICU admission (26.3% vs 91.8%; P <.001) and invasive mechanical ventilation (12.6% vs 82.2%; P <.001).
In a multivariable Cox regression analysis, increased risk of 28-day mortality among patients with CAPA was associated with higher neutrophil-lymphocyte ratio (≥5.7; hazard ratio [HR], 95% CI, 1.257-5.112; P =.009) and receipt of at least 3 antibiotics (HR, 2.517; 95% CI, 1.170-5.413; P =.018).
Limitations of this study include the single-center design and the small sample size.
According to the researchers, “The risk factors of CAPA and death obtained from the study can help us further understand the disease characteristics of CAPA and better guide our clinical decision-making.”
This article originally appeared on Infectious Disease Advisor
