Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study
Abstract Background The reported incidence of aspergillosis among COVID-19 patients has varied significantly, which can be partly attributed to differences in diagnostic approaches and levels of physicians’ proficiency in diagnosing COVID-19-associated pulmonary aspergillosis (CAPA). Consequently, w...
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BMC
2025-04-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-025-03671-4 |
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| author | Li-jing Xia Tong-tong Hou Xi-ling Liu Xue-bing Chen Peng-cheng Lin Shan-shan Su Li Yang Ying Zhou Yu-ping Li |
| author_facet | Li-jing Xia Tong-tong Hou Xi-ling Liu Xue-bing Chen Peng-cheng Lin Shan-shan Su Li Yang Ying Zhou Yu-ping Li |
| author_sort | Li-jing Xia |
| collection | DOAJ |
| description | Abstract Background The reported incidence of aspergillosis among COVID-19 patients has varied significantly, which can be partly attributed to differences in diagnostic approaches and levels of physicians’ proficiency in diagnosing COVID-19-associated pulmonary aspergillosis (CAPA). Consequently, we conducted a retrospective study to investigate the potential reasons for these discrepancies and analyzed the risk factors for pulmonary aspergillosis in patients with COVID-19. Method Data were retrospectively collected from December 1, 2022, to September 30, 2023, from patients who were admitted to the First Affiliated Hospital of Wenzhou Medical University. The research platform was used to screen patients with discharge diagnoses of COVID-19 pneumonia. CAPA was defined according to the 2020 ECMM/ISHAM criteria and the Chinese expert consensus. Clinical data that were collected included data about underlying diseases, laboratory examinations and microbiological detection. Analyses were conducted with R software, with continuous variables analyzed with t-tests, categorical variables analyzed with chi-square tests, and logistic regression and ROC curves used to assess risk factors for CAPA. Results The incidence of CAPA was 13.4% in the general ward, 30.8% in the RICU, and 6.8% in other ICUs. The average time to CAPA diagnosis was 5.6 days in general wards, 3.7 days in the RICU, and 7.4 days in other ICUs. Diagnostic testing revealed the following sensitivities: 78% for BALF galactomannan (GM), 48% for serum GM, 52% for culture tests, and 71% for BALF mNGS. Risk factors for CAPA included chronic respiratory disease, chronic renal insufficiency, and diabetes. The primary Aspergillus species identified was A. fumigatus, followed by A. flavus. Conclusion Differences in incidence may arise from varying levels of physician awareness, which can influence the rate at which BALF and serum GM samples are submitted for testing. The sensitivity of BALF GM is higher than that of serum GM. Furthermore, BALF mNGS has the potential to enhance the clinical detection sensitivity of CAPA. Risk factors for CAPA include chronic respiratory disease, chronic renal insufficiency, and diabetes, which may aid in identifying at-risk patients. The primary Aspergillus species identified was A. fumigatus, followed by A. flavus, providing a reference for clinical empirical treatment. Clinical trial number Not applicable. |
| format | Article |
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| institution | OA Journals |
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| publishDate | 2025-04-01 |
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| series | BMC Pulmonary Medicine |
| spelling | doaj-art-d9f23e03170c40c4b078284d2cc78cfe2025-08-20T02:30:19ZengBMCBMC Pulmonary Medicine1471-24662025-04-0125111110.1186/s12890-025-03671-4Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective studyLi-jing Xia0Tong-tong Hou1Xi-ling Liu2Xue-bing Chen3Peng-cheng Lin4Shan-shan Su5Li Yang6Ying Zhou7Yu-ping Li8The Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityDepartment of Medical Record, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityThe Key Laboratory of Interventional Pulmonology of Zhejiang Province, Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical UniversityAbstract Background The reported incidence of aspergillosis among COVID-19 patients has varied significantly, which can be partly attributed to differences in diagnostic approaches and levels of physicians’ proficiency in diagnosing COVID-19-associated pulmonary aspergillosis (CAPA). Consequently, we conducted a retrospective study to investigate the potential reasons for these discrepancies and analyzed the risk factors for pulmonary aspergillosis in patients with COVID-19. Method Data were retrospectively collected from December 1, 2022, to September 30, 2023, from patients who were admitted to the First Affiliated Hospital of Wenzhou Medical University. The research platform was used to screen patients with discharge diagnoses of COVID-19 pneumonia. CAPA was defined according to the 2020 ECMM/ISHAM criteria and the Chinese expert consensus. Clinical data that were collected included data about underlying diseases, laboratory examinations and microbiological detection. Analyses were conducted with R software, with continuous variables analyzed with t-tests, categorical variables analyzed with chi-square tests, and logistic regression and ROC curves used to assess risk factors for CAPA. Results The incidence of CAPA was 13.4% in the general ward, 30.8% in the RICU, and 6.8% in other ICUs. The average time to CAPA diagnosis was 5.6 days in general wards, 3.7 days in the RICU, and 7.4 days in other ICUs. Diagnostic testing revealed the following sensitivities: 78% for BALF galactomannan (GM), 48% for serum GM, 52% for culture tests, and 71% for BALF mNGS. Risk factors for CAPA included chronic respiratory disease, chronic renal insufficiency, and diabetes. The primary Aspergillus species identified was A. fumigatus, followed by A. flavus. Conclusion Differences in incidence may arise from varying levels of physician awareness, which can influence the rate at which BALF and serum GM samples are submitted for testing. The sensitivity of BALF GM is higher than that of serum GM. Furthermore, BALF mNGS has the potential to enhance the clinical detection sensitivity of CAPA. Risk factors for CAPA include chronic respiratory disease, chronic renal insufficiency, and diabetes, which may aid in identifying at-risk patients. The primary Aspergillus species identified was A. fumigatus, followed by A. flavus, providing a reference for clinical empirical treatment. Clinical trial number Not applicable.https://doi.org/10.1186/s12890-025-03671-4CAPAIncidenceRICUGeneral wardsOther ICUsBALF GM |
| spellingShingle | Li-jing Xia Tong-tong Hou Xi-ling Liu Xue-bing Chen Peng-cheng Lin Shan-shan Su Li Yang Ying Zhou Yu-ping Li Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study BMC Pulmonary Medicine CAPA Incidence RICU General wards Other ICUs BALF GM |
| title | Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study |
| title_full | Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study |
| title_fullStr | Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study |
| title_full_unstemmed | Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study |
| title_short | Impact of physician awareness and microbiological examination on incidence of COVID-19-associated pulmonary aspergillosis: a retrospective study |
| title_sort | impact of physician awareness and microbiological examination on incidence of covid 19 associated pulmonary aspergillosis a retrospective study |
| topic | CAPA Incidence RICU General wards Other ICUs BALF GM |
| url | https://doi.org/10.1186/s12890-025-03671-4 |
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