Discussion and conclusion
respiratory failure, aspergillosis
LUNG DISEASE, ASPERGILLOSIS, SARS-COV-2 INFECTION, ADVERSE EVENT, RESPIRATORY FAILURE, EVENTS, DRUG-DRUG INTERACTION
In this multicenter observational study, antifungal prophylaxis with nebulized amphotericin-B among SOTRs admitted to ICU with COVID-19 showed a trend to lower the incidence of CAPA: 1 of 19 patients (5.3%) using this prophylaxis compared with 9 of 44 (20.5%) without prophylaxis. These results suggest that nebulized amphotericin-B might be effective in preventing CAPA in SOTRs. Our results are in line with two previous observational studies that showed a reduction in CAPA diagnosis in ICU-admitted COVID-19 patients with posaconazole (Our study has several limitations. Adverse events were not recorded prospectively in a standardized format and intolerance may therefore be underreported. Nonetheless, no discontinuation of prophylaxis due to side effects was recorded. Antifungal prophylaxis assignment was not randomized, meaning that baseline characteristics were not completely balanced between the two study groups. However, most known risk factors for aspergillosis were more common in the prophylaxis group (e.g., prior cytomegalovirus viremia, high-dose corticosteroids for COVID-19 and preexisting lung disease). In addition, none of the CAPA cases could be classified as proven, underlying the difficulties in diagnosing CAPA in ICU admitted patients. Despite the multicenter study design, the study population is small and included few CAPA events, and this limits both the reproducibility and the generalizability of the results of the study itself. However, the observed CAPA prevalence in this study might have been underestimated in the absence of standardized screening. Given that the range of CAPA prevalence is wide in other studies, it may not be possible to extrapolate our results to other geographic regions.Despite the limitations of our research, targeted antifungal prophylaxis with nebulized amphotericin-B may still be justified for SOTRs admitted to ICU with COVID-19. First, patients admitted to ICU with COVID-19 have an estimated prevalence of 18%–19% for CAPA (In conclusion, SOTRs admitted to ICU with respiratory failure due to SARS-CoV-2 infection have an elevated risk of CAPA. Nebulized amphotericin B represents an attractive choice for the prevention of CAPA in this high-risk population, benefiting from being effective and safe, while lacking drug-drug interactions (