Verweij, Paul E., Bruggemann, Roger J. M., Azoulay, Elie ORCID: 0000-0002-8162-1508, Bassetti, Matteo, Blot, Stijn ORCID: 0000-0003-2145-0345, Buil, Jochem B., Calandra, Thierry ORCID: 0000-0003-3051-1285, Chiller, Tom, Clancy, Cornelius J., Cornely, Oliver A., Depuydt, Pieter, Koehler, Philipp ORCID: 0000-0002-7386-7495, Lagrou, Katrien, de Lange, Dylan, Lass-Florl, Cornelia ORCID: 0000-0002-2946-7785, Lewis, Russell E., Lortholary, Olivier, Liu, Peter-Wei Lun, Maertens, Johan, Nguyen, M. Hong, Patterson, Thomas F., Rijnders, Bart J. A., Rodriguez, Alejandro, Rogers, Thomas R., Schouten, Jeroen A., Wauters, Joost, van de Veerdonk, Frank L. and Martin-Loeches, Ignacio (2021). Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis. Intensive Care Med., 47 (8). S. 819 - 835. NEW YORK: SPRINGER. ISSN 1432-1238

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Abstract

Purpose Invasive pulmonary aspergillosis (IPA) is increasingly reported in patients with severe coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU). Diagnosis and management of COVID-19 associated pulmonary aspergillosis (CAPA) are challenging and our aim was to develop practical guidance. Methods A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology. Results The prevalence of CAPA varied between 0 and 33%, which may be partly due to variable case definitions, but likely represents true variation. Bronchoscopy and bronchoalveolar lavage (BAL) remain the cornerstone of CAPA diagnosis, allowing for diagnosis of invasive Aspergillus tracheobronchitis and collection of the best validated specimen for Aspergillus diagnostics. Most patients diagnosed with CAPA lack traditional host factors, but pre-existing structural lung disease and immunomodulating therapy may predispose to CAPA risk. Computed tomography seems to be of limited value to rule CAPA in or out, and serum biomarkers are negative in 85% of patients. As the mortality of CAPA is around 50%, antifungal therapy is recommended for BAL positive patients, but the decision to treat depends on the patients' clinical condition and the institutional incidence of CAPA. We recommend against routinely stopping concomitant corticosteroid or IL-6 blocking therapy in CAPA patients. Conclusion CAPA is a complex disease involving a continuum of respiratory colonization, tissue invasion and angioinvasive disease. Knowledge gaps including true epidemiology, optimal diagnostic work-up, management strategies and role of host-directed therapy require further study.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Verweij, Paul E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruggemann, Roger J. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Azoulay, ElieUNSPECIFIEDorcid.org/0000-0002-8162-1508UNSPECIFIED
Bassetti, MatteoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Blot, StijnUNSPECIFIEDorcid.org/0000-0003-2145-0345UNSPECIFIED
Buil, Jochem B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calandra, ThierryUNSPECIFIEDorcid.org/0000-0003-3051-1285UNSPECIFIED
Chiller, TomUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Clancy, Cornelius J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cornely, Oliver A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Depuydt, PieterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koehler, PhilippUNSPECIFIEDorcid.org/0000-0002-7386-7495UNSPECIFIED
Lagrou, KatrienUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
de Lange, DylanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lass-Florl, CorneliaUNSPECIFIEDorcid.org/0000-0002-2946-7785UNSPECIFIED
Lewis, Russell E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lortholary, OlivierUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Liu, Peter-Wei LunUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maertens, JohanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nguyen, M. HongUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patterson, Thomas F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rijnders, Bart J. A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rodriguez, AlejandroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rogers, Thomas R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schouten, Jeroen A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wauters, JoostUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van de Veerdonk, Frank L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Martin-Loeches, IgnacioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-607458
DOI: 10.1007/s00134-021-06449-4
Journal or Publication Title: Intensive Care Med.
Volume: 47
Number: 8
Page Range: S. 819 - 835
Date: 2021
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1432-1238
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
CRITICALLY-ILL PATIENTS; INVASIVE ASPERGILLOSIS; VORICONAZOLE PHARMACOKINETICS; POSACONAZOLE; DIFFERENTIATION; GUIDELINES; SOCIETY; BETA; ICUMultiple languages
Critical Care MedicineMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60745

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