Bibliographic Details
| Title: |
'CAPA in Progress': A New Real-Life Approach for the Management of Critically Ill COVID-19 Patients |
| Authors: |
Nieves Carbonell, María Jesús Alcaráz, Ainhoa Serrano-Lázaro, María Rodríguez-Gimillo, David Sánchez Ramos, Francisco Ros, Josep Ferrer, María Luisa Blasco, David Navarro, María Ángeles Clari |
| Source: |
Biomedicines, Vol 10, Iss 7, p 1683 (2022) |
| Publisher Information: |
MDPI AG, 2022. |
| Publication Year: |
2022 |
| Collection: |
LCC:Biology (General) |
| Subject Terms: |
COVID-19, critically ill patients, CAPA, “CAPA in progress”, galactomannan, Aspergillus spp., Biology (General), QH301-705.5 |
| More Details: |
(1) Background: COVID-19-associated pulmonary aspergillosis (CAPA) has worsened the prognosis of patients with pneumonia and acute respiratory distress syndrome admitted to the intensive care unit (ICU). The lack of specific diagnosis criteria is an obstacle to the timely initiation of appropriate antifungal therapy. Tracheal aspirate (TA) has been employed under special pandemic conditions. Galactomannan (GM) antigens are released during active fungal growth. (2) Methods: We proposed the term “CAPA in progress” (CAPA-IP) for diagnosis at an earlier stage by GM testing on TA in a specific population admitted to ICU presenting with clinical deterioration. A GM threshold ≥0.5 was set as the mycological inclusion criterion. This was followed by a pre-emptive short-course antifungal. (3) Results: We prospectively enrolled 200 ICU patients with COVID-19. Of these, 164 patients (82%) initially required invasive mechanical ventilation and GM was tested in TA in 93 patients. A subset of 19 patients (11.5%) fulfilled the CAPA-IP criteria at a median of 9 days after ICU admittance. The median GM value was 3.25 ± 2.82. CAPA-IP cases showed significantly higher ICU mortality [52.6% (10/19) vs. 34.5% (50/145), p = 0.036], as well as a much longer median ICU stay than those with a normal GM index [27 (7–64) vs. 11 (9–81) days, p = 0.008]. All cases were treated with a pre-emptive systemic antifungal for a median time of 19 (3–39) days. (4) Conclusions: CAPA-IP highlights a new real-life early approach in the field of fungal stewardship in ICU programs. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
2227-9059 |
| Relation: |
https://www.mdpi.com/2227-9059/10/7/1683; https://doaj.org/toc/2227-9059 |
| DOI: |
10.3390/biomedicines10071683 |
| Access URL: |
https://doaj.org/article/d7ad6258e0fd4e6a98beeb8e1e2c51f0 |
| Accession Number: |
edsdoj.7ad6258e0fd4e6a98beeb8e1e2c51f0 |
| Database: |
Directory of Open Access Journals |
