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Mycobiome analyses of critically ill COVID-19 patients

Summary

This study examined fungal infections in severely ill COVID-19 patients treated in intensive care units across Europe. Researchers found that a dangerous mold called Aspergillus fumigatus was more common in patients who died and less common in those treated with azole antifungal drugs. The findings suggest that giving antifungal medications to critically ill COVID-19 patients when they arrive at the hospital might help prevent fungal-related deaths.

Background

COVID-19-associated pulmonary aspergillosis (CAPA) is a life-threatening complication in severely ill COVID-19 patients. Previous studies have linked increased fungal burden in critically ill COVID-19 patients to prolonged mechanical ventilation and increased mortality. However, specific mycobiome signatures associated with severe COVID-19 severity and the impact of antifungal prophylaxis have not been thoroughly characterized.

Objective

To characterize the composition of the respiratory mycobiome in critically ill COVID-19 patients with and without CAPA and to determine the impact of antifungal drug prophylaxis on patient outcomes. The study examined 39 COVID-19 patients in intensive care units across multiple centers.

Results

Respiratory mycobiomes were dominated by Candida and Aspergillus species. Increased A. fumigatus burden was associated with mortality, and azole use at ICU admission was linked with absence of A. fumigatus. No significant association was found between corticosteroid use or CAPA diagnosis and respiratory fungal communities.

Conclusion

Mold-active antifungal treatment at ICU admission may be linked with reduced A. fumigatus-associated mortality in severe COVID-19. The findings suggest prophylactic azole treatment could be beneficial for reducing fungal co-infections in critically ill COVID-19 patients, though further studies are warranted.
  • Published in:Microbiology Spectrum,
  • Study Type:Multinational Retrospective Cohort Study,
  • Source: PMID: 39699254, DOI: 10.1128/spectrum.04110-23
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