A National Strategy to Diagnose COVID-19 Associated Invasive Fungal Disease in the ICU

Rationale: Fungal co-infection is a recognised complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in COVID-19 patients with severe respiratory distress are being reported, but comprehensive data is lacking. Objectives: To determine the incidence, risk factors and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress. Methods: An evaluation of a national, multi-centre, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients. Measurements and Main Results: One-hundred and thirty-five adults (median age: 57, M/F: 2·2/1) were screened. The incidence was 25·9% (13·3% aspergillosis, 12·6% yeast infections). The overall mortality rate was 38%; 51% and 31% in patients with and without fungal disease, respectively (P: 0·0398). The mortality rate was reduced by the use of antifungal therapy (Mortality: 38·5% in patients receiving therapy versus 89% in patients not receiving therapy (P: 0·0178). The use of corticosteroids (P: 0·002) and history of chronic respiratory disease (P: 0·043) increased the likelihood of aspergillosis. Conclusions: Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.