Active Surveillance of Cytomegalovirus Infection, Pneumocystis Pneumonia, and Pulmonary Aspergillosis in Critically Ill Patients with COVID-19

Abstract Diagnosing opportunistic infections is important in critically ill patients with coronavirus disease 2019 (COVID-19); however, incidence and risk determination are challenging because biopsy is difficult. Therefore, this study comprehensively analyzed the risk factors using active surveillance data. Active surveillance included weekly serum cytomegalovirus, sputum Pneumocystis jirovecii , and galactomannan test testing. The incidence and risk of Pneumocystis pneumonia (PCP) and COVID-19-associated pulmonary aspergillosis (CAPA) were determined from clinical features. Among 210 patients who underwent active surveillance, serum cytomegalovirus, sputum pneumocystis, and galactomannan antigens were detected at least once in 29.0%, 7.6%, and 59.0% of patients, respectively, with first detection at medians of weeks 3 (interquartile range [IQR] 1–4), 0 (0–0.25), and 0 (0–1), respectively. PCP and CAPA occurred in 1.4% and 14.3% of patients, respectively, with diagnoses at medians of weeks 0 (0–0.5), and 2 (1–3) weeks. Treatment for CMV was started at a median of 4 (3–5) weeks. High-dose steroids were risk factors for cytomegalovirus viremia and CAPA. Cytomegalovirus viremia tended to develop and be diagnosed later than CAPA. Compared to CAPA, the incidence of Pneumocystis jiroveci pneumonia (PJP) was low in critically ill patients with COVID-19.