Impact of negative air pressure in ICU rooms on the risk of pulmonary aspergillosis in COVID-19 patients
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RESEARCH LETTER
Open Access
Impact of negative air pressure in ICU rooms on the risk of pulmonary aspergillosis in COVID-19 patients Philippe Ichai1* , Faouzi Saliba1, Patricia Baune2, Asma Daoud1, Audrey Coilly1 and Didier Samuel1 From the start of the COVID-19 epidemic, one recommendation regarding the intensive care management of COVID-19 patients concerned the infrastructure in intensive care units (ICU) and particularly the air pressure system in ICU rooms [1]. Under normal circumstances and mainly in ICUs hosting immunocompromised patients, ICU rooms are equipped with positive air room pressure in order to protect patients against infections from the surrounding environment and particularly those due to Aspergillus fumigatus (AF). This link between positive pressure rooms and a reduction in Aspergillus infection rates has been demonstrated during several studies [2]. However, these studies included numerous other associated preventive measures. The relationship between the fungal levels in the air of neutral pressure rooms and those in positive pressure rooms has not been established [3]. During the current COVID-19 pandemic, on the contrary, the recommendations have been to place intensive care rooms under negative or even normal pressure so as to protect the staff and patients healthcare. Two recent studies reported a high incidence (26.3–33%) of pulmonary aspergillosis in COVID-19 infected patients [4, 5]. This high risk of pulmonary aspergillosis was also seen in patients with severe influenza (19%). Thevissen et al. reported that the rate of influenza-associated pulmonary aspergillosis (IAPA) varied according to country and that variation in IAPA prevalence might be related to underdiagnosis due to lower use of galactomannan
testing on broncho-alveolar lavage or serum in some areas [6]. In line with these recommendations, the 15 rooms of our ICU were placed under negative pressure to receive COVID-19 patients. During this change, all filters in the air conditioning unit were replaced. Two months earlier, routine air sampling had not revealed the presence of any fungal agents and our annual incidence of aspergillosis was lower than 2%. Between 23 March and 4 May 2020, 26 COVID-19 patients were admitted to our ICU (Table 1). Six of the 26 (23.1%) developed probable or proven pulmonary aspergillosis, while two were colonized by AF. Air cultures from the rooms occupied by the first four infected patients revealed the presence of AF. No colonies of AF were found on the surfaces in rooms or in the air of stepdown rooms (same building, same geographical orientation, two floors up) that were sampled Table 1 Principal characteristics of patients with probable or proven pulmonary aspergillosis Mean age (SD): 64 ± 9 years Gender (n males): 18 M ARDS due to COVID-19, n = 21 Delay between admission and the diagnosis of aspergillosis: 6.5 ± 4.2 days Antifungal therapy: 6/6 - Isavuconazole, n = 5 - Voriconazole, n = 1 Alive: 4/6 patients (67%)
* Correspondence: [email protected] 1 Liver Intensive Care Unit, Ce
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