Anticipatory Antifungal Treatment in Critically Ill Patients with SARS-CoV-2 Pneumonia.

BACKGROUND: The aim of this study was to investigate the incidence of COVID-19-associated pulmonary aspergillosis (CAPA) in critically ill patients and the impact of anticipatory antifungal treatment on the incidence of CAPA in critically ill patients. METHODS: Before/after observational study in a mixed intensive care unit (ICU) of a university teaching hospital. The study took place between March 2020 and June 2022. Inclusion criteria were critically ill patients with severe SARS-CoV-2 pneumonia requiring invasive mechanical ventilation. Two analysis periods were compared according to whether or not antifungal therapy was given early. RESULTS: A total of 160 patients with severe SARS-CoV-2 pneumonia and invasive mechanical ventilation were included. The incidence of CAPA in the first study period was 19 out of 58 patients (32.75%); during the second period, after implementation of the intervention (anticipatory antifungal therapy), the incidence of CAPA decreased to 10.78% (11 out of 102 patients). In patients with CAPA under invasive mechanical ventilation, the mortality rate decreased from 100% to 64%. CONCLUSIONS: Anticipating antifungal treatment in patients with SARS-CoV-2 pneumonia under invasive mechanical ventilation was associated with a decrease in the incidence and mortality of pulmonary aspergillosis.

Vaccinated Patients Admitted in ICU with Severe Pneumonia Due to SARS-CoV-2: A Multicenter Pilot Study.

Background: The aim of this study was to analyze the percentage of patients admitted to the ICU having received the vaccine against COVID-19, to describe the clinical profile of vaccinated patients admitted to the ICU, and to assess the humoral immune response to vaccination. Methods: In this multicenter prospective descriptive cohort study, consecutive critically ill patients with confirmed SARS-CoV-2 pneumonia who received at least one dose of the SARS-CoV-2 vaccine were included. The time of study was from 1 July to 10 August of 2021. Results: Of the 94 consecutive patients from seven Andalusian ICUs admitted during the time of study, 50 (53.2%) received at least one dose of anti SARS-CoV-2 vaccine. No patient was admitted having previously had SARS-CoV-2 infection. The B.1.617.2 (Delta) variant was the most frequently identified, in 80.76% of cases. Patients with a complete vaccination with non-optimal antibody levels were immunocompromised. Fifteen patients were admitted to the ICU with Acute Respiratory Distress Syndrome (ARDS) without having completed their vaccination; the clinical profile was younger and with less comorbidities compared to patients with full vaccination. There were no differences in severity of ARDS. Conclusions: Most of the patients who were admitted to the ICU having received a dose of the vaccine were not optimally vaccinated; fully vaccinated patients who did not obtain optimal serum antibody levels were patients considered immunocompromised.

Cardiac troponin-T in acute pericarditis.

INTRODUCTION: The long-term outcome of acute pericarditis with high cardiac troponin-T (cTnT) is unknown. Our purpose was to investigate the prognostic and clinical value of cTnT in myopericardial inflammatory syndromes. METHODS: Between January 2001 and September 2011, 107 patients hospitalized for acute pericarditis or myopericarditis were enrolled. Postinfarction pericarditis and neoplastic pericarditis were excluded. Physical examination, ECG, echocardiography and blood tests were performed. RESULTS: Among the 105 patients (89% men, mean age 36 ±â€Š15 years-old), a cTnT rise was detectable in 64 patients (60.9%). Only younger age was found as an independent factor for higher values of cTnT in multivariate analysis (P = 0.03). After a mean follow-up of 51 months, a similar rate of complications was found in patients with a positive or a negative cTnT test: recurrent pericarditis (11 vs. 19%, P = 0.23) and cardiac tamponade (2 vs. 5%, P = 0.56). No cases of constrictive pericarditis, residual left ventricular dysfunction or hospital death were detected. The left ventricular ejection fraction remained unchanged during the follow-up (62.6 ±â€Š6.5 vs. 61.9 ±â€Š5.8, P = 0.89). CONCLUSION: In acute pericarditis, a cTnT rise is a frequent finding and commonly found in younger patients. However, unlike acute coronary syndrome, cTnT rise is not a negative prognostic marker.