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“CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients

(1) Background: COVID-19-associated pulmonary aspergillosis (CAPA) has worsened the prognosis of patients with pneumonia and acute respiratory distress syndrome admitted to the intensive care unit (ICU). The lack of specific diagnosis criteria is an obstacle to the timely initiation of appropriate a...

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Autores principales: Carbonell, Nieves, Alcaráz, María Jesús, Serrano-Lázaro, Ainhoa, Rodríguez-Gimillo, María, Sánchez Ramos, David, Ros, Francisco, Ferrer, Josep, Blasco, María Luisa, Navarro, David, Clari, María Ángeles
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313341/
https://www.ncbi.nlm.nih.gov/pubmed/35884988
http://dx.doi.org/10.3390/biomedicines10071683
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author Carbonell, Nieves
Alcaráz, María Jesús
Serrano-Lázaro, Ainhoa
Rodríguez-Gimillo, María
Sánchez Ramos, David
Ros, Francisco
Ferrer, Josep
Blasco, María Luisa
Navarro, David
Clari, María Ángeles
author_facet Carbonell, Nieves
Alcaráz, María Jesús
Serrano-Lázaro, Ainhoa
Rodríguez-Gimillo, María
Sánchez Ramos, David
Ros, Francisco
Ferrer, Josep
Blasco, María Luisa
Navarro, David
Clari, María Ángeles
author_sort Carbonell, Nieves
collection PubMed
description (1) Background: COVID-19-associated pulmonary aspergillosis (CAPA) has worsened the prognosis of patients with pneumonia and acute respiratory distress syndrome admitted to the intensive care unit (ICU). The lack of specific diagnosis criteria is an obstacle to the timely initiation of appropriate antifungal therapy. Tracheal aspirate (TA) has been employed under special pandemic conditions. Galactomannan (GM) antigens are released during active fungal growth. (2) Methods: We proposed the term “CAPA in progress” (CAPA-IP) for diagnosis at an earlier stage by GM testing on TA in a specific population admitted to ICU presenting with clinical deterioration. A GM threshold ≥0.5 was set as the mycological inclusion criterion. This was followed by a pre-emptive short-course antifungal. (3) Results: We prospectively enrolled 200 ICU patients with COVID-19. Of these, 164 patients (82%) initially required invasive mechanical ventilation and GM was tested in TA in 93 patients. A subset of 19 patients (11.5%) fulfilled the CAPA-IP criteria at a median of 9 days after ICU admittance. The median GM value was 3.25 ± 2.82. CAPA-IP cases showed significantly higher ICU mortality [52.6% (10/19) vs. 34.5% (50/145), p = 0.036], as well as a much longer median ICU stay than those with a normal GM index [27 (7–64) vs. 11 (9–81) days, p = 0.008]. All cases were treated with a pre-emptive systemic antifungal for a median time of 19 (3–39) days. (4) Conclusions: CAPA-IP highlights a new real-life early approach in the field of fungal stewardship in ICU programs.
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spelling pubmed-93133412022-07-26 “CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients Carbonell, Nieves Alcaráz, María Jesús Serrano-Lázaro, Ainhoa Rodríguez-Gimillo, María Sánchez Ramos, David Ros, Francisco Ferrer, Josep Blasco, María Luisa Navarro, David Clari, María Ángeles Biomedicines Article (1) Background: COVID-19-associated pulmonary aspergillosis (CAPA) has worsened the prognosis of patients with pneumonia and acute respiratory distress syndrome admitted to the intensive care unit (ICU). The lack of specific diagnosis criteria is an obstacle to the timely initiation of appropriate antifungal therapy. Tracheal aspirate (TA) has been employed under special pandemic conditions. Galactomannan (GM) antigens are released during active fungal growth. (2) Methods: We proposed the term “CAPA in progress” (CAPA-IP) for diagnosis at an earlier stage by GM testing on TA in a specific population admitted to ICU presenting with clinical deterioration. A GM threshold ≥0.5 was set as the mycological inclusion criterion. This was followed by a pre-emptive short-course antifungal. (3) Results: We prospectively enrolled 200 ICU patients with COVID-19. Of these, 164 patients (82%) initially required invasive mechanical ventilation and GM was tested in TA in 93 patients. A subset of 19 patients (11.5%) fulfilled the CAPA-IP criteria at a median of 9 days after ICU admittance. The median GM value was 3.25 ± 2.82. CAPA-IP cases showed significantly higher ICU mortality [52.6% (10/19) vs. 34.5% (50/145), p = 0.036], as well as a much longer median ICU stay than those with a normal GM index [27 (7–64) vs. 11 (9–81) days, p = 0.008]. All cases were treated with a pre-emptive systemic antifungal for a median time of 19 (3–39) days. (4) Conclusions: CAPA-IP highlights a new real-life early approach in the field of fungal stewardship in ICU programs. MDPI 2022-07-13 /pmc/articles/PMC9313341/ /pubmed/35884988 http://dx.doi.org/10.3390/biomedicines10071683 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Carbonell, Nieves
Alcaráz, María Jesús
Serrano-Lázaro, Ainhoa
Rodríguez-Gimillo, María
Sánchez Ramos, David
Ros, Francisco
Ferrer, Josep
Blasco, María Luisa
Navarro, David
Clari, María Ángeles
“CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients
title “CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients
title_full “CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients
title_fullStr “CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients
title_full_unstemmed “CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients
title_short “CAPA in Progress”: A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients
title_sort “capa in progress”: a new real-life approach for the management of critically ill covid-19 patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9313341/
https://www.ncbi.nlm.nih.gov/pubmed/35884988
http://dx.doi.org/10.3390/biomedicines10071683
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