M Hong Nguyen, Sixto M Leal, Luis Ostrosky-Zeichner, Andrej Spec, George R Thompson, Thomas F Patterson, John Baddley, Rachel McMullen, Drashti Shah, Cornelius J Clancy, Gerald McGwin, Peter G Pappas
{"title":"美国7家医院机械通气患者中与covid -19相关的肺曲霉病：流行病学和侵袭性肺曲霉病的估计可能性-前瞻性MSG-017研究的结果","authors":"M Hong Nguyen, Sixto M Leal, Luis Ostrosky-Zeichner, Andrej Spec, George R Thompson, Thomas F Patterson, John Baddley, Rachel McMullen, Drashti Shah, Cornelius J Clancy, Gerald McGwin, Peter G Pappas","doi":"10.1093/ofid/ofaf331","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is no prospective, US multicenter study of COVID-19-associated pulmonary aspergillosis (CAPA). CAPA definitions do not differentiate invasive aspergillosis (IPA) from colonization. Validity of single mycologic test results is unclear.</p><p><strong>Methods: </strong>We performed a prospective 7-center US study of mechanically ventilated adults with COVID-19 (April 2021-May 2022). Mycoses Study Group (MSGERC) CAPA criteria include host and clinical factors, imaging and test results (histopathology; bronchoalveolar lavage [BAL] culture and/or BAL or serum galactomannan-immunoassay). Proven, putative, and unlikely IPA were defined by clinical criteria. CAPA-unlikely IPA criteria included survival or negative autopsy following no/limited antifungal treatment. IPA likelihood was estimated using sensitivity/specificity of tests from autopsy data.</p><p><strong>Results: </strong>CAPA incidence was 7% (14/212). Independent CAPA risk factors were EORTC/MSGERC host factor and cavitary lesions. Seven percent, 79%, and 14% of CAPA patients had proven, putative, and unlikely IPA, respectively. Respective estimated IPA likelihoods were 84%, 7%-99%, and 1%-8%. Overall, median estimated IPA likelihood was 30%. Patients with CAPA-unlikely IPA had a single positive BAL galactomannan-immunoassay with other negative tests. CAPA mortality (71%) was not impacted by antifungal treatment or significantly different than without CAPA. CAPA incidence was 10% and 16% by European Confederation of Medical Mycology and Public Health Wales definitions, respectively. IPA was unlikely in 75% (6/8) and 57% (13/23) diagnosed by these definitions but not MSGERC.</p><p><strong>Conclusions: </strong>CAPA is associated with high mortality, but IPA's contribution is unclear. Single positive tests are insufficient for diagnosing CAPA-IPA. IPA likelihood is best estimated by combining test results (both positive and negative).</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 7","pages":"ofaf331"},"PeriodicalIF":3.8000,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268869/pdf/","citationCount":"0","resultStr":"{\"title\":\"COVID-19-associated Pulmonary Aspergillosis in Mechanically Ventilated Patients at 7 US Hospitals: Epidemiology and Estimated Likelihood of Invasive Pulmonary Aspergillosis-Results of the Prospective MSG-017 Study.\",\"authors\":\"M Hong Nguyen, Sixto M Leal, Luis Ostrosky-Zeichner, Andrej Spec, George R Thompson, Thomas F Patterson, John Baddley, Rachel McMullen, Drashti Shah, Cornelius J Clancy, Gerald McGwin, Peter G Pappas\",\"doi\":\"10.1093/ofid/ofaf331\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is no prospective, US multicenter study of COVID-19-associated pulmonary aspergillosis (CAPA). CAPA definitions do not differentiate invasive aspergillosis (IPA) from colonization. Validity of single mycologic test results is unclear.</p><p><strong>Methods: </strong>We performed a prospective 7-center US study of mechanically ventilated adults with COVID-19 (April 2021-May 2022). Mycoses Study Group (MSGERC) CAPA criteria include host and clinical factors, imaging and test results (histopathology; bronchoalveolar lavage [BAL] culture and/or BAL or serum galactomannan-immunoassay). Proven, putative, and unlikely IPA were defined by clinical criteria. CAPA-unlikely IPA criteria included survival or negative autopsy following no/limited antifungal treatment. IPA likelihood was estimated using sensitivity/specificity of tests from autopsy data.</p><p><strong>Results: </strong>CAPA incidence was 7% (14/212). Independent CAPA risk factors were EORTC/MSGERC host factor and cavitary lesions. Seven percent, 79%, and 14% of CAPA patients had proven, putative, and unlikely IPA, respectively. Respective estimated IPA likelihoods were 84%, 7%-99%, and 1%-8%. Overall, median estimated IPA likelihood was 30%. Patients with CAPA-unlikely IPA had a single positive BAL galactomannan-immunoassay with other negative tests. CAPA mortality (71%) was not impacted by antifungal treatment or significantly different than without CAPA. CAPA incidence was 10% and 16% by European Confederation of Medical Mycology and Public Health Wales definitions, respectively. IPA was unlikely in 75% (6/8) and 57% (13/23) diagnosed by these definitions but not MSGERC.</p><p><strong>Conclusions: </strong>CAPA is associated with high mortality, but IPA's contribution is unclear. Single positive tests are insufficient for diagnosing CAPA-IPA. IPA likelihood is best estimated by combining test results (both positive and negative).</p>\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":\"12 7\",\"pages\":\"ofaf331\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-07-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268869/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofaf331\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofaf331","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
COVID-19-associated Pulmonary Aspergillosis in Mechanically Ventilated Patients at 7 US Hospitals: Epidemiology and Estimated Likelihood of Invasive Pulmonary Aspergillosis-Results of the Prospective MSG-017 Study.
Background: There is no prospective, US multicenter study of COVID-19-associated pulmonary aspergillosis (CAPA). CAPA definitions do not differentiate invasive aspergillosis (IPA) from colonization. Validity of single mycologic test results is unclear.
Methods: We performed a prospective 7-center US study of mechanically ventilated adults with COVID-19 (April 2021-May 2022). Mycoses Study Group (MSGERC) CAPA criteria include host and clinical factors, imaging and test results (histopathology; bronchoalveolar lavage [BAL] culture and/or BAL or serum galactomannan-immunoassay). Proven, putative, and unlikely IPA were defined by clinical criteria. CAPA-unlikely IPA criteria included survival or negative autopsy following no/limited antifungal treatment. IPA likelihood was estimated using sensitivity/specificity of tests from autopsy data.
Results: CAPA incidence was 7% (14/212). Independent CAPA risk factors were EORTC/MSGERC host factor and cavitary lesions. Seven percent, 79%, and 14% of CAPA patients had proven, putative, and unlikely IPA, respectively. Respective estimated IPA likelihoods were 84%, 7%-99%, and 1%-8%. Overall, median estimated IPA likelihood was 30%. Patients with CAPA-unlikely IPA had a single positive BAL galactomannan-immunoassay with other negative tests. CAPA mortality (71%) was not impacted by antifungal treatment or significantly different than without CAPA. CAPA incidence was 10% and 16% by European Confederation of Medical Mycology and Public Health Wales definitions, respectively. IPA was unlikely in 75% (6/8) and 57% (13/23) diagnosed by these definitions but not MSGERC.
Conclusions: CAPA is associated with high mortality, but IPA's contribution is unclear. Single positive tests are insufficient for diagnosing CAPA-IPA. IPA likelihood is best estimated by combining test results (both positive and negative).
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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