Introduction
COVID-19-associated pulmonary aspergillosis, pulmonary mold infections, fungal superinfection, viral infections
ADVERSE EVENTS, CYTOMEGALOVIRUS DISEASE, INVASIVE PULMONARY ASPERGILLOSIS, VIRAL INFECTION, COMPLICATION, MUCORMYCOSIS
Edited by: Jon Salmanton-Garcia, University Hospital of Cologne, GermanyReviewed by: Maddalena Peghin, University of Insubria, Italy; Giuseppe Gentile, Department of Translational and Precision Medicine, Sapienza University of Rome, Italy; Janina Trauth, Uniklinikum Giessen und Marburg, Germany; Dora Edith Corzo-Leon, University of Exeter, United Kingdom†ORCID: Alexander Rombauts, COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as a frequent complication in the intensive care unit (ICU). However, little is known about this life-threatening fungal superinfection in solid organ transplant recipients (SOTRs), including whether targeted anti-mold prophylaxis might be justified in this immunosuppressed population. We performed a multicentric observational retrospective study of all consecutive ICU-admitted COVID-19 SOTRs between August 1, 2020 and December 31, 2021. SOTRs receiving antifungal prophylaxis with nebulized amphotericin-B were compared with those without prophylaxis. CAPA was defined according the ECMM/ISHAM criteria. Sixty-four SOTRs were admitted to ICU for COVID-19 during the study period. One patient received antifungal prophylaxis with isavuconazole and was excluded from the analysis. Of the remaining 63 SOTRs, nineteen (30.2%) received anti-mold prophylaxis with nebulized amphotericin-B. Ten SOTRs who did not receive prophylaxis developed pulmonary mold infections (nine CAPA and one mucormycosis) compared with one who received nebulized amphotericin-B (22.7% vs 5.3%; risk ratio 0.23; 95%CI 0.032-1.68), but with no differences in survival. No severe adverse events related to nebulized amphotericin-B were recorded. SOTRs admitted to ICU with COVID-19 are at high risk for CAPA. However, nebulized amphotericin-B is safe and might reduce the incidence of CAPA in this high-risk population. A randomized clinical trial to confirm these findings is warranted.Several studies have shown an association between invasive pulmonary aspergillosis and viral infections, such as cytomegalovirus disease (Solid organ transplant recipients (SOTRs) are at increased risk of severe COVID-19 (Antifungal prophylaxis might be justified for high-risk groups due to the incidence and mortality of CAPA in ICUs. Unfortunately, antifungal prophylaxis in SOTRs is not without challenges. Drug-drug interactions exist between triazoles and the most common immunosuppressants (calcineurin inhibitors and mammalian target of rapamycin [mTOR] inhibitors) (In this retrospective study, we aimed to evaluate the impact of antifungal prophylaxis with nebulized amphotericin-B in SOTRs admitted to ICU for COVID-19.