Results
COVID-19-associated pulmonary aspergillosis, pulmonary aspergillosis
CYTOMEGALOVIRUS, CORONAVIRUS DISEASE 2019, PULMONARY ASPERGILLOSIS, ASPERGILLOSIS, COVID-19 PNEUMONIA, ADVERSE EFFECTS, CORONAVIRUS, PULMONARY MUCORMYCOSIS, SEVERE ACUTE RESPIRATORY SYNDROME, BRONCHOSPASM
During the study period, 64 SOTRs were admitted to ICUs with COVID-19 pneumonia. Of the 20 patients, (31.3%) who received antifungal prophylaxis, 19 received nebulized amphotericin-B, while one patient receiving isavuconazole prophylaxis was excluded from the analysis.The analyzed sample included 63 SOTRs (mean age, 62.1 ± 11.7 years), 49 renal, 6 lung, 4 heart, 3 liver, and 1 pancreas/kidney recipients, of which 16 (25.4%) had undergone transplantation in the 6 months before ICU admission. Maintenance immunosuppression typically included tacrolimus (90.5%) with mycophenolate (85.7%), whereas the acute treatment of COVID-19 included corticosteroids (96.8%), tocilizumab (25.4%), and remdesivir (9.5%), with 77.7% requiring invasive mechanical ventilation. The in-hospital mortality rate was 57.1%.The mean time to CAPA diagnosis after ICU admission was 6.8 ± 5.8 days, with intensivists diagnosing 1 possible and 9 probable cases of aspergillosis, together with 1 case of pulmonary mucormycosis (17.4%). The ECMM/ISHAM criteria used to establish pulmonary aspergillosis can be found in the Supplementary Material (The characteristics of patients with and without prophylaxis are shown in Comparison between SOTRs with and without anti-mold prophylaxis at ICU admission for COVID-19.ATG, Anti-thymocyte globulin; CMV, cytomegalovirus; COVID-19, Coronavirus disease 2019; ICU, Intensive care unit; SARS-CoV-2; mTOR, mechanistic target of rapamycin; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SOTR, Solid organ transplant recipient.All received nebulized amphotericin-B.One patient received a simultaneous pancreas-kidney transplant.Tacrolimus + cyclosporine.High-dose corticosteroids for COVID-19 pneumonia was defined if the patient received a threshold of prednisone equivalent of 75mg/day.Ten COVID-19-associated pulmonary aspergillosis and one pulmonary mucormycosis.ns, not significant (p>0.05).Concerning adverse effects, only 1 of the 19 patients receiving nebulized amphotericin-B prophylaxis developed mild-to-moderate bronchospasm, and this did not require the interruption of prophylaxis. Finally, in-hospital mortality was comparable between groups.