Invasive Fungal Diseases in Hospitalized Patients with COVID-19 in Israel: A Multicenter Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Data Collection and Definitions
2.3. Statistical Analyses
3. Results
3.1. Invasive Candidiasis
3.2. Pulmonary Mold Disease
3.3. Outcomes
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Invasive Candidiasis | Pulmonary Mold Disease | Total |
---|---|---|---|
Total | 40 | 33 | 71 |
Sex | |||
Male | 28 (70.0) | 21 (63.6) | 47 (66.1) |
Female | 12 (30.0) | 12 (36.4) | 24 (33.8) |
Age, years, median (IQR) | 64.5 (57–74.2) | 64 (59–74) | 64 (59–74) |
Charlson Comorbidity score, median (IQR) | 2 (1–4) | 2 (1–3) | 2 (1–4) |
COPD | 4 (10.3) | 4 (12.1) | 8 (11.2) |
Diabetes mellitus | 11 (28.2) | 12 (36.4) | 24 (33.8) |
Ischemic heart disease | 9 (23.9) | 9 (27.3) | 17 (23.9) |
Cerebrovascular disease | 4 (10.3) | 2 (6.1) | 6 (8.4) |
Immune suppression | 6 (15.0) | 5 (15.2) | 11 (15.1) |
Dementia | 3 (7.5) | 0 (0) | 3 (4.2) |
LTCF residence | 3 (7.5) | 0 (0) | 3 (4.2) |
COVID-19 category | |||
Non-severe | 2 (5.0) | 1 (3.0) | 3 (4.2) |
Severe | 5 (12.5) | 1 (3.0) | 6 (8.4) |
Critical | 33 (82.5) | 31 (93.9) | 62 (87.3) |
SOFA score, median (IQR) | 10 (7.5–13) | 7 (5–11) | 9 (6–12) |
ICU | 29 (74.4) | 31 (93.9) | 58 (81.6) |
Mechanical ventilation | 32 (82.1) | 31 (93.9) | 61 (85.9) |
Time from diagnosis, median (IQR) | 18.5 (12–28) | 16 (10–28) | 17 (11–28) |
MV days before IFD, median (IQR) | 12 (3–24) | 7 (1–16) | 9 (1–18) |
ICU days before IFD, median (IQR) | 16 (8–24) | 10 (3–17) | 12 (4.7–18) |
CVC | 34 (87.2) | 28 (84.8) | 60 (84.5) |
Urinary catheter | 33 (84.6) | 32 (97.0) | 64 (90.1) |
Chest tube | 6 (15.4) | 4 (12.1) | 9 (12.6) |
Bacterial infection | 25 (64.1) | 24 (72.7) | 46 (64.7) |
Corticosteroids | 35 (89.7) | 31 (93.9) | 64 (90.1) |
Tocilizumab | 5 (12.8) | 5 (15.2) | 10 (14.0) |
Remdesivir | 14 (35.9) | 9 (27.3) | 23 (32.3) |
Broad-spectrum antibiotics | 32 (82.1) | 30 (90.9) | 61 (85.9) |
Complications | |||
Pneumothorax/Pneumomediastinum | 9 (23.1) | 6 (18.2) | 13 (18.3) |
Venous thromboembolism | 3 (7.7) | 6 (18.2) | 9 (12.6) |
Outcomes | |||
Days in ICU | 24 (12–44) | 24 (15–35) | 24 (14–37.5) |
Days on ventilator | 13 (3.5–40) | 28.5 (15–42) | 22 (8–41) |
Days in hospital | 30 (14–41) | 33 (23–52) | 31 (20–46) |
Crude hospital mortality | 27 (67.5) | 19 (57.5) | 45 (63.3) |
BSI | IC | Total | |
---|---|---|---|
Total | 34 (100) | 6 (100) | 40 (100) |
CVC-associated BSI | 13 (38.2) | NA | 13 (33.3) |
Pleural empyema | 2 (5.8) | 4 (66.6) | 6 (15.4) |
Peritonitis | 1 (2.9) | 1 (16.6) | 2 (5.1) |
Biliary | 0 (0) | 1 (16.6) | 1 (2.6) |
Undetermined source | 18 (52.9) | NA | 18 (45) |
Candida species | |||
C. glabrata | 13 (38.2) | 0 (0) | 13 (32.5) |
C. albicans | 7 (20.5) | 2 (33.3) | 9 (22.5) |
C. parapsilosis | 6 (17.6) | 1 (16.6) | 7 (17.5) |
C. tropicalis | 4 (11.7) | 0 (0) | 4 (10.0) |
C. lusitaniae | 2 (5.8) | 0 (0) | 2 (5.0) |
C. krusei | 1 (2.9) | 0 (0) | 1 (2.5) |
C. dubliniensis | 0 (0) | 1 (16.6) | 1 (2.5) |
C. auris | 1 (2.9) | 0 (0) | 1 (2.5) |
Mixed species | 0 (0) | 2 (33.3) | 2 (5.0) |
Variable | N (%) |
---|---|
Aspergillus species | |
A. fumigatus | 13 (39.4) |
A. flavus | 8 (24.2) |
A. terreus | 5 (15.2) |
Aspergillus spp. | 6 (18.2) |
Rhizopus arrhizus | 1 (3.03) |
Positive Culture | 26/33 (78.8) |
Positive Galactomannan | |
Airway | 14/26 (53.8) |
Plasma | 6/22 (27.3) |
Positive PCR | 2/17 (11.8) |
Total | 33 (100) |
Variable | IC | PMD |
---|---|---|
Age > 65 years | 2.84 (1.34–6.02) | 1.76 (0.75–4.10) |
SOFA score > 12 | 3.64 (1.46–9.05) | 0.76 (0.097–5.99) |
Charlson score > 2 | 1.72 (0.81–3.65) | 1.74 (0.70–4.32) |
Primary treatment | ||
Echinocandin | 0.44 (0.20–0.94) | 1.68 (0.56–5.075) |
Fluconazole | 0.92 (0.39–2.17) | NA |
Extended-spectrum azole | NA | 0.23 (0.093–0.57) |
Cox proportional hazards model | ||
Age > 65 years | 3.52 (1.26–9.77) | NA |
SOFA score > 12 | 7.37 (2.38–22.77) | NA |
Echinocandin | 0.26 (0.07–0.91) | NA |
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Elbaz, M.; Korem, M.; Ayalon, O.; Wiener-Well, Y.; Shachor-Meyouhas, Y.; Cohen, R.; Bishara, J.; Atamna, A.; Brosh-Nissimov, T.; Maaravi, N.; et al. Invasive Fungal Diseases in Hospitalized Patients with COVID-19 in Israel: A Multicenter Cohort Study. J. Fungi 2022, 8, 721. https://doi.org/10.3390/jof8070721
Elbaz M, Korem M, Ayalon O, Wiener-Well Y, Shachor-Meyouhas Y, Cohen R, Bishara J, Atamna A, Brosh-Nissimov T, Maaravi N, et al. Invasive Fungal Diseases in Hospitalized Patients with COVID-19 in Israel: A Multicenter Cohort Study. Journal of Fungi. 2022; 8(7):721. https://doi.org/10.3390/jof8070721
Chicago/Turabian StyleElbaz, Meital, Maya Korem, Oshrat Ayalon, Yonit Wiener-Well, Yael Shachor-Meyouhas, Regev Cohen, Jihad Bishara, Alaa Atamna, Tal Brosh-Nissimov, Nir Maaravi, and et al. 2022. "Invasive Fungal Diseases in Hospitalized Patients with COVID-19 in Israel: A Multicenter Cohort Study" Journal of Fungi 8, no. 7: 721. https://doi.org/10.3390/jof8070721