法国MYCOVID研究:COVID-19机械通气患者的真菌感染率高达22%

2021-12-06 小文子 MedSci原创

机械通气的COVID-19患者中,侵袭性肺曲霉菌病和念珠菌血症和高死亡率与pr/pb CAPA相关。

重症COVID-19患者已成为侵袭性真菌感染(IFI)的高危人群。然而,目前尚未对机械通气患者的IFIs患病率进行评估。Lancet Respir Med杂志的一项研究评估了重症COVID-19机械通气患者的侵袭性真菌感染的患病率,危险因素和死亡率。

在法国18个ICU进行了一项全国多中心、观察性队列研究。纳入确诊SARS-CoV-2感染、因急性呼吸窘迫综合征需要机械通气的成年患者,收集人口统计学、临床和生物学随访数据。机械通气至离开ICU期间,每周对患者进行一次或两次呼吸道真菌微生物系统筛查主要结局是ICU治疗期间至少筛查三个微生物样本的符合条件患者的IFI患病率,根据最新的ECMM/ISHAM定义,确诊/临床诊断COVID-19相关肺曲霉菌病(pr/pb CAPA)。次要结局是确诊/临床诊断CAPA的危险因素、pr/pb CAPA组和非pr/pb CAPA组的ICU死亡率,以及pr/pb CAPA与ICU死亡率相关变量之间的相关性。

2020.2.29-2020.7.9期间,研究共纳入565例COVID-19机械通气患者。分析了至少有三个筛查样本的509例患者(平均年龄59.4岁[SD 12.5],400例[79%]男性)。128例(25%)患者发生138次确诊/临床诊断或疑似IFIs。76例(15%)患者符合pr/pb CAPA标准。根据多变量分析,年龄大于62岁(OR=2.34, [95%CI, 1.39-3.92],p=0.0013)、地塞米松和抗IL-6治疗(OR=2.71, [1.12-6.56],p=0.027)和机械通气持续时间较长(>14天;OR=2.16, [1.14-4.09],p=0.019)与pr/pb CAPA独立相关。38例(7%)患者有一种或多种pr/pb IFIs:32例(6%)有念珠菌血症,6例(1%)有侵袭性毛霉菌病,1例(<1%)有侵袭性镰刀菌病。校正念珠菌血症后,509例患者的死亡相关性多变量分析确定三个重要因素:年龄大于62岁(HR=1.71, [95%CI, 1.26-2.32],p=0.0005)、实体器官移植(HR=2.46, [1.53-3.95],p=0.0002)和pr/pb CAPA(HR=1.45, [95%CI, 1.03-2.03],p=0.033)。离开ICU时,生存曲线显示,pr/pb CAPA患者的ICU总死亡率显著高于无pr/pb CAPA患者,分别为61.8%(95%CI, 50.0-72.8)和32.1%(27.7-36.7;p<0.0001)。

研究表明,机械通气的COVID-19患者中,侵袭性肺曲霉菌病和念珠菌血症和高死亡率与pr/pb CAPA相关。强调了对重症COVID-19患者进行真菌病原体主动监测的必要性。

原文出处:

Jean-Pierre Gangneux, Eric Dannaoui, Arnaud Fekkar, et al, Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study, Lancet Respir Med 2021, https://doi.org/10.1016/ S2213-2600(21)00442-2.

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    2022-04-07 飞行的小土豆

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    2021-12-07 guihongzh
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    2021-12-07 zhaojie88
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    2021-12-07 neurowu

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