TY - JOUR
T1 - Absence of COVID-19 associated mucormycosis in a tertiary intensive care unit in the Netherlands
AU - Schippers, J. R.
AU - Verweij, P. E.
AU - Heunks, L. M. A.
AU - van Dijk, K.
AU - the ArtDECO consortium
AU - Nossent, Esther J.
AU - Duitman, JanWillem
AU - Saris, Anno
AU - de Vries, Heder
AU - Meijboom, Lilian J.
AU - Bos, Lieuwe D. J.
AU - Blok, Siebe G.
AU - Schuurman, Alex R.
AU - Reijnders, Tom D. Y.
AU - Vallejo, Juan J. Garcia
AU - Bontkes, Hetty
AU - Vlaar, Alexander P. J.
AU - Wiersinga, W. Joost
AU - Lutter, René
AU - van der Poll, Tom
AU - Bogaard, Harm Jan
AU - Heunks, Leo
AU - Zhang, Shiqi
AU - Kullberg, Robert F. J.
AU - de Brabander, Justin
AU - Boers, Leonoor S.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - Mucormycosis is a severe complication in critically ill COVID-19 patients. Throughout the pandemic, a notable prevalence of mucormycosis has been observed in the Indian population, whereas lower occurrences have been reported in Europe. However, limited data exist regarding its prevalence in Europe, which is potentially underestimated due to the low sensitivity of bronchoalveolar lavage (BAL) cultures. We aimed to evaluate the prevalence of mucormycosis in a high-risk critically ill COVID-19 population in the Netherlands, and to evaluate the potential benefit of adding Mucor PCR to BAL as part of routine follow-up. In this study, we included 1035 critically ill COVID-19 patients admitted to either one of the two ICUs at AmsterdamUMC between March 2020 and May 2022; of these, 374 had undergone at least one bronchoscopy. Following the AmsterdamUMC protocols, bronchoscopies were conducted weekly until clinical improvement was achieved. We cultured BAL fluid for fungi and used PCR and galactomannan testing to detect Aspergillus spp. Additionally, we retrospectively performed qPCR targeting Mucorales DNA in the BAL of 89 deceased patients. All cultures were negative for Mucorales, whereas 42 (11%) cultures were positive for Aspergillus. Furthermore, qPCR targeting Mucorales was negative in all 89 deceased patients. This study showed that pulmonary mucormycosis was not present in critically ill COVID-19 patients in two tertiary care ICUs. These results indicate routine Mucorales qPCR screening is not clinically necessary in a high-standard-of-care tertiary ICU in a low-endemic area.
AB - Mucormycosis is a severe complication in critically ill COVID-19 patients. Throughout the pandemic, a notable prevalence of mucormycosis has been observed in the Indian population, whereas lower occurrences have been reported in Europe. However, limited data exist regarding its prevalence in Europe, which is potentially underestimated due to the low sensitivity of bronchoalveolar lavage (BAL) cultures. We aimed to evaluate the prevalence of mucormycosis in a high-risk critically ill COVID-19 population in the Netherlands, and to evaluate the potential benefit of adding Mucor PCR to BAL as part of routine follow-up. In this study, we included 1035 critically ill COVID-19 patients admitted to either one of the two ICUs at AmsterdamUMC between March 2020 and May 2022; of these, 374 had undergone at least one bronchoscopy. Following the AmsterdamUMC protocols, bronchoscopies were conducted weekly until clinical improvement was achieved. We cultured BAL fluid for fungi and used PCR and galactomannan testing to detect Aspergillus spp. Additionally, we retrospectively performed qPCR targeting Mucorales DNA in the BAL of 89 deceased patients. All cultures were negative for Mucorales, whereas 42 (11%) cultures were positive for Aspergillus. Furthermore, qPCR targeting Mucorales was negative in all 89 deceased patients. This study showed that pulmonary mucormycosis was not present in critically ill COVID-19 patients in two tertiary care ICUs. These results indicate routine Mucorales qPCR screening is not clinically necessary in a high-standard-of-care tertiary ICU in a low-endemic area.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85179646546&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/38092785
U2 - 10.1038/s41598-023-47231-4
DO - 10.1038/s41598-023-47231-4
M3 - Article
C2 - 38092785
SN - 2045-2322
VL - 13
JO - Scientific reports
JF - Scientific reports
IS - 1
M1 - 22134
ER -