Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. COVID-19-Associated Pulmonary Aspergillosis (CAPA)
3.2. COVID-19-Associated Candidiasis
3.3. COVID-19-Associated Mucormycosis (CAM) and Cryptococcosis (CACr)
3.4. IFI Cases during the Time of Pandemic
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | General n = 156 (%) | IFI n = 78 (%) | Controls n = 78 (%) | Bivariate p |
---|---|---|---|---|
Age, mean (SD) | 56.6 (14.1) | 56.5 (14.2) | 57.8 (14.1) | 0.9 |
Male Sex | 112 (72) | 56 (72) | 56 (72) | 1.0 |
Comorbidities | ||||
Obesity | 81 (52) | 42 (54) | 39 (50) | 0.63 |
Overweight | 56 (36) | 28 (36) | 28 (36) | 0.95 |
Arterial hypertension | 53 (34) | 27 (35) | 26 (33) | 0.86 |
Type 2 diabetes mellitus | 49 (32) | 23 (29.5) | 26 (38) | 0.56 |
Immunosuppression | 7 (4.5) | 7 (9) | 0 | 0.01 |
Pulmonary disease | 7 (4.5) | 5 (6) | 2 (2.5) | 0.44 |
Smoking | 23 (15) | 13 (17) | 10 (13) | 0.49 |
Charlson ≥ 4 | 22 (14) | 12 (15) | 10 (13) | 0.65 |
Severity scores | ||||
APACHE II Score ≥ 10 | 73 (47) | 38 (49) | 35 (45) | 0.63 |
SOFA score > 2 | 126 (81) | 72 (92) | 54 (69) | <0.01 |
Lymphopenia * | 107 (69) | 49 (63) | 58 (74) | 0.12 |
SARS-CoV-2 PCR Ct < 24 | 52 (33) | 27 (35) | 25 (32) | 0.73 |
COVID-19 treatment | ||||
Tocilizumab | 10 (27) | 7 (37) | 3 (17) | 0.16 |
Remdesivir | 4 (11) | 2 (10.5) | 2 (10.5) | 0.95 |
Empiric antibiotic | 99 (63.5) | 72 (92) | 27 (35) | <0.01 |
Dexamethasone | 103 (66) | 47 (60) | 56 (72) | 0.12 |
Hospital stay, mdn (IQR) | 26 (17–41.5) | 34.5 (23–51) | 21 (12–29) | <0.01 |
ICU stay, mdn (IQR) | 18 (11–28) | 22 (16–41) | 13 (7–24) | <0.01 |
IMV duration, mdn (IQR) | 15.5 (9.5–25.5) | 20 (14–31) | 11 (7–22) | <0.01 |
Prolonged IMV (>21 days) | 56 (36) | 35 (45) | 21 (27) | 0.02 |
Prone position | 115 (74) | 61 (78) | 54 (69) | 0.20 |
Vasopressors | 124 (79.5) | 70 (90) | 54 (69) | 0.002 |
Hemodialysis | 12 (8) | 9 (11.5) | 3 (4) | 0.07 |
Myocardial injury | 24 (15) | 17 (22) | 7 (9) | 0.03 |
Pulmonary Venous thrombosis | 21 (13.5) | 12 (15) | 9 (11.5) | 0.48 |
Bacterial co-infection $ | 92 (59) | 49 (63) | 43 (55) | 0.33 |
VAP | 77 (87.5) | 38 (84) | 39 (91) | 0.37 |
In-hospital mortality | 72 (46) | 38 (49) | 34 (44) | 0.52 |
Variables | Multivariate Analysis |
---|---|
SOFA score > 2 | aOR 5.1, 95% CI 1.5–16.8, p = 0.007 |
Empiric antibiotic | aOR 30, 95% CI 10.2–87.6, p = <0.01 |
Prolonged IVM | aOR 2.3, 95% 0.9–6.2, p = 0.09 |
Dexamethasone | aOR 0.81, 95% CI 0.31–2.1, p = 0.68 |
Lymphopenia | aOR 0.56, 95% CI 0.20–1.5, p = 0.27 |
Characteristics | All CAPA Cases n = 47 (%) | Probable CAPA n = 15 (%) | Possible CAPA n = 32 (%) | p Bivariate |
---|---|---|---|---|
Male sex | 34 (72) | 14 (93) | 20 (62.5) | 0.02 |
Age, mean (SD) | 57.3 (14.3) | 53.3 (15.9) | 59.2 (13.4) | 0.18 |
Obesity | 23 (49) | 6 (40) | 17 (53) | 0.40 |
Immunosuppression | 6 (13) | 3 (20) | 3 (9) | 0.30 |
Severity scores | ||||
APACHE II Score ≥ 10 | 23 (49) | 3 (20) | 20 (62.5) | 0.007 |
SOFA score > 2 | 45 (96) | 15 (100) | 30 (94) | 0.32 |
Lymphopenia | 31 (66) | 8 (53) | 23 (72) | 0.21 |
Empiric antibiotic previous ICU | 42 (89) | 14 (83) | 28 (87.5) | 0.54 |
Dexamethasone | 30 (64) | 10 (67) | 20 (62.5) | 0.78 |
CAPA diagnosis | ||||
Persistent Fever | 14 (30) | 7 (47) | 7 (22) | 0.08 |
Recurrent Fever | 32 (68) | 9 (60) | 23 (72) | 0.41 |
Worsening ventilatory parameters | 36 (77) | 12 (80) | 24 (75) | 0.70 |
Chest CT for diagnosis | 31 (66) | 11 (73) | 20 (62.5) | 0.46 |
Antifungal treatment | 40 (85) | 15 (100) | 25 (78) | 0.05 |
Death | 27 (57.5) | 7 (47) | 20 (62.5) | 0.30 |
Characteristic/Patient | CAM Patient 1 | CAM Patient 2 | CAM Patient 3 | CACr Patient 1 | CACr Patient 2 | CACr Patient 3 |
---|---|---|---|---|---|---|
Sex | Male | Male | Male | Male | Male | Male |
Age | 62 | 68 | 51 | 51 | 86 | 70 |
Comorbidity | Obesity | Talcum pulmonary silicosis | Uncontrolled Diabetes | Uncontrolled Diabetes | Health previously | Health previously |
Risk Factor | None | Lymphopenia | Lymphopenia | Lymphopenia | None | None |
Dexamethasone for COVID-19 | Yes | Yes | Yes | Yes | Yes | Yes |
Site of infection | Pulmonary/ Sinusitis | Pulmonary | Pulmonary/ Sinusitis | Pulmonary/ meningeal | Pulmonary | Pulmonary/ Pleural |
Clinic | Fever, anosmia, dysgeusia, cyanosis without dyspnea | Dry cough, sore throat, fever, dyspnea | Cephalea, dry cough, arthralgia, myalgia, dyspnea | Fever (38.5 °C), dry cough, dyspnea | Dyspnea, backache, cephalea | General discomfort, diarrhea, dyspnea |
CT finding | Thorax: progression of pneumonia, crazy paving, consolidation Paranasal: Pansinusitis | Thorax: progression of pneumonia, micronodular Paranasal: none | Thorax: progression of pneumonia, ground glass opacities, consolidation CT paranasal: Pansinusitis | Thorax: progression of pneumonia, ground glass opacities Brain MRI: bilateral frontotemporal pachymeningitis | Thorax: progression of pneumonia, ground glass opacities, and apical nodule | Thorax: pulmonary embolism, ground glass opacities, subpleural cyst, pneumatocele, hydro-pneumothorax |
Mycologic | Rhizopus spp. in TA | Rhizopus oryzae in TA | Lichteimia corymbifera TA | Cryptococcus neoformans in TA Negative antigen LF in CSF | Cryptococcus neoformans in TA | Cryptococcus neoformans in pleural effusion |
Treatment | Posaconazole | Isavuconazole | Isavuconazole | Amphotericin B + Fluconazole | Non-treatment (post-mortem diagnosis) | Fluconazole |
Outcome | Dead | Alive | Dead | Alive | Dead | Dead |
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Roman-Montes, C.M.; Bojorges-Aguilar, S.; Corral-Herrera, E.A.; Rangel-Cordero, A.; Díaz-Lomelí, P.; Cervantes-Sanchez, A.; Martinez-Guerra, B.A.; Rajme-López, S.; Tamez-Torres, K.M.; Martínez-Gamboa, R.A.; et al. Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico. J. Fungi 2023, 9, 583. https://doi.org/10.3390/jof9050583
Roman-Montes CM, Bojorges-Aguilar S, Corral-Herrera EA, Rangel-Cordero A, Díaz-Lomelí P, Cervantes-Sanchez A, Martinez-Guerra BA, Rajme-López S, Tamez-Torres KM, Martínez-Gamboa RA, et al. Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico. Journal of Fungi. 2023; 9(5):583. https://doi.org/10.3390/jof9050583
Chicago/Turabian StyleRoman-Montes, Carla M., Saul Bojorges-Aguilar, Ever Arturo Corral-Herrera, Andrea Rangel-Cordero, Paulette Díaz-Lomelí, Axel Cervantes-Sanchez, Bernardo A. Martinez-Guerra, Sandra Rajme-López, Karla María Tamez-Torres, Rosa Areli Martínez-Gamboa, and et al. 2023. "Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico" Journal of Fungi 9, no. 5: 583. https://doi.org/10.3390/jof9050583