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?:abstract
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BACKGROUND COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8-33.3% have been reported depending on the geographic area, with high (47%) mortality. OBJECTIVES Here we describe a single-center prospective case series with CAPA cases from both the first (March-May, n=5/33) and second (mid-September through mid-December, n=8/33) COVID-19 wave at a 500-bed teaching hospital in the Netherlands. PATIENTS/METHODS In the first COVID-19 wave, a total of 265 SARS-CoV-2 PCR positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS-CoV-2 PCR positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. RESULTS We found a significant decrease in COVID-19 patients needing mechanical ventilation in the ICU in the second wave (p<0.01). From these patients however, a higher percentage were diagnosed with CAPA (24.2% versus 15.2%), although not significant (p=0.36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40-50%). Moreover, we found environmental TR34 /L98H azole-resistant Aspergillus fumigatus isolates in two separate patients. CONCLUSIONS In this series, 19.7% (n=13/66) of mechanically ventilated SARS-CoV-2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID-19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine if there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS-CoV-2 therapy.
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