Invasive fungal disease common among critically ill COVID-19 patients, study finds
Invasive fungal disease occurs often in critically ill patients with COVID-19 on mechanical ventilation, according to a study published in Clinical Infectious Diseases.
“With the COVID-19 pandemic far from over, it is paramount that our understanding of the risk from associated invasive fungal disease is enhanced,” P. Lewis White, PhD, FECMM, FRCPath, consultant clinical scientist and head of the mycology reference laboratory for Public Health Wales, told Healio.
White and colleagues screened 135 patients with COVID-19 for invasive fungal disease to evaluate an enhanced testing strategy. The patients were from a national, multicenter cohort in Wales.
The incidence of invasive fungal disease was 26.7% — 14.1% aspergillosis and 12.6% yeast infections. The overall mortality rate was 38%, including 53% in patients with fungal disease and 31% in patients without it (P = .0387). The overall mortality rate declined when antifungal therapy was used. It was 38.5% in patients who received antifungal therapy vs. 90% in patients who did not (P = .008).
White said they did not expect the high rate of invasive yeast infections.
“While we feel this was not directly associated to the COVID-19 disease process, it highlights the pressures exerted on ICU staff managing large numbers of complex patients, complicated by the necessity to wear [personal protective equipment],” White said.
White said two of the study’s major limitations were that the optimal diagnostic strategy was not applied to every patient and sampling was performed under the discretion of a consulting clinician.
“This could be addressed by adherence to a strict optimal protocol, but this was not a clinical trial and represents data generated from a routine clinical service, which represents the real-life situation,” White said. “Nevertheless, the study did highlight that combining the testing of blood and respiratory samples using a range of tests was optimal and this approach will be advocated for future clinical testing.”