日本2019冠状病毒病相关肺曲霉病的全国流行病学调查

IF 1.5 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-05-26 DOI:10.1016/j.jiac.2025.102739

Yuya Ito , Takahiro Takazono , Hotaka Namie , Masato Tashiro , Hiroshi Kakeya , Yoshitsugu Miyazaki , Hiroshi Mukae , Hiroshige Mikamo , Tomoo Fukuda , Kazutoshi Shibuya , Koichi Izumikawa

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引用次数: 0

摘要

背景2019冠状病毒病（COVID-19）相关肺曲霉病（CAPA）是COVID-19的严重并发症，预后较差。在本研究中，我们旨在分析日本全国范围内CAPA的流行病学。方法：这项全国性的回顾性研究包括2020年1月至2023年8月期间日本221家医院报告的98例CAPA患者的数据，采用在线和纸质问卷调查。我们研究了CAPA的临床特征，使用Kaplan-Meier曲线评估了结果，并使用Cox比例风险分析确定了90天死亡率的独立预测因素。结果CAPA患者的中位年龄为71岁，男性占71.4%。β- d -葡聚糖和血清半乳甘露聚糖抗原阳性率分别为59.1%和68.4%，胸部ct显示胸腔空腔率为25.5%。30天和90天死亡率分别为50.0%和55.1%。Kaplan-Meier分析显示，单药治疗的患者死亡率显著高于其他抗真菌药物治疗的患者（log-rank检验，p = 0.04）。多因素分析发现，中性粒细胞计数≥10,000/μL（风险比[HR]: 2.67, 95%可信区间[CI]: 1.49-4.89）和棘白菌素单药治疗（风险比：2.06,95% CI: 1.01-3.93）是90天死亡率的独立预测因素。接受棘白菌素单药治疗的患者年龄较大，其中一半患者未分离出曲霉。结论本研究对日本的CAPA进行了较为全面的综述。适当的抗真菌治疗对改善CAPA患者的预后至关重要。

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A nationwide epidemiological survey of coronavirus disease 2019-associated pulmonary aspergillosis in Japan

Background

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe complication of COVID-19 with a poor prognosis. In this study, we aimed to analyze the nationwide epidemiology of CAPA in Japan.

Methods

This nationwide retrospective study involved data of 98 patients with CAPA reported in 221 hospitals in Japan between January 2020 and August 2023, using both online and paper-based questionnaires. We investigated the clinical characteristics of CAPA, assessed outcomes using Kaplan–Meier curves, and identified independent predictors of 90-day mortality using Cox proportional hazards analysis.

Results

The median age of the patients with CAPA was 71 years, and 71.4 % were men. The positivity rates for β-D-glucan and serum galactomannan antigen were 59.1 % and 68.4 %, respectively, while chest computed tomography revealed cavities in 25.5 % of patients. The 30-day and 90-day mortality rates were 50.0 % and 55.1 %, respectively. Kaplan–Meier analysis showed that the mortality rate of patients treated with echinocandin monotherapy was significantly higher than that of patients treated with other antifungals (log-rank test, p = 0.04). Multivariate analysis identified a neutrophil count of ≥10,000/μL (hazard ratio [HR]: 2.67, 95 % confidence interval [CI]: 1.49–4.89) and echinocandin monotherapy (HR: 2.06, 95 % CI: 1.01–3.93) as independent predictors of 90-day mortality. Patients treated with echinocandin monotherapy were older, and Aspergillus spp. was not isolated in half of these patients.

Conclusion

This study provides a comprehensive overview of CAPA in Japan. Appropriate antifungal therapy is essential to improve the prognosis of patients with CAPA.

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.