Observational studyCritical care (London, England)2021
Antifungal prophylaxis for prevention of COVID-19-associated pulmonary aspergillosis in critically ill patients: an observational study.
Observational study in Critical care (London, England), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
60 citing papers in PubMed, 5 syntheses or guidelines pooled it, 93 citations in OpenAlex.
- Incidence, mortality and risk factors of invasive pulmonary aspergillosis in critically ill patients during the COVID-19 era: a global systematic review and meta-analysis.Annals of clinical microbiology and antimicrobials · 2026Pooled it
- Antifungal prophylaxis among critically ill COVID-19 patients: a meta-analysis and systematic review.BMC infectious diseases · 2026Pooled it
- Guideline
- Aspergillus fumigatus-a systematic review to inform the World Health Organization priority list of fungal pathogens.Medical mycology · 2024Pooled it
- Mycotic infection as a risk factor for COVID-19: A meta-analysis.Frontiers in public health · 2022Pooled it
- Aspergillus fumigatus biology, immunopathogenicity and drug resistance.Nature reviews. Microbiology · 2025Review
- Optimization and Characterization of Bioactive Metabolites from Cave-DerivedBiomolecules · 2025Article
- COVID-19-associated Pulmonary Aspergillosis in Mechanically Ventilated Patients at 7 US Hospitals: Epidemiology and Estimated Likelihood of Invasive Pulmonary Aspergillosis-Results of the Prospective MSG-017 Study.Open forum infectious diseases · 2025Article
- Performance of Diagnostic Algorithms in Patients With Invasive Pulmonary Aspergillosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Article
- Lateral Flow DeviceOpen forum infectious diseases · 2025Article
- Invasive Aspergillosis in the Intensive Care Unit.Journal of fungi (Basel, Switzerland) · 2025Review
- Article
- Article
- Antifungal prophylaxis of COVID-19 associated pulmonary aspergillosis in ventilated patients: one solution does not fit all.Intensive care medicine · 2024Article
- Severe mold fungal infections in critically ill patients with COVID-19.Future microbiology · 2024Review
- Review
- Study protocol: A randomized, double-blind, placebo-controlled trial of isavuconazole prophylaxis for the prevention of covid-19-associated pulmonary aspergillosis.Contemporary clinical trials communications · 2024Article
- Antifungals in Patients With Extracorporeal Membrane Oxygenation: Clinical Implications.Open forum infectious diseases · 2024Review
- Invasive Pulmonary Aspergillosis in Critically Ill Patients with Hantavirus Infection, Austria.Emerging infectious diseases · 2024Article
- Invasive pulmonary aspergillosis among patients with severe community-acquired pneumonia and influenza in ICUs: a retrospective cohort study.Pneumonia (Nathan Qld.) · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundCoronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) emerged as important fungal complications in patients with COVID-19-associated severe acute respiratory failure (ARF). Whether mould active antifungal prophylaxis (MAFP) can prevent CAPA remains elusive so far.
methodsIn this observational study, we included all consecutive patients admitted to intensive care units with COVID-19-associated ARF between September 1, 2020, and May 1, 2021. We compared patients with versus without antifungal prophylaxis with respect to CAPA incidence (primary outcome) and mortality (secondary outcome). Propensity score adjustment was performed to account for any imbalances in baseline characteristics. CAPA cases were classified according to European Confederation of Medical Mycology (ECMM)/International Society of Human and Animal Mycoses (ISHAM) consensus criteria.
resultsWe included 132 patients, of whom 75 (57%) received antifungal prophylaxis (98% posaconazole). Ten CAPA cases were diagnosed, after a median of 6 days following ICU admission. Of those, 9 CAPA cases were recorded in the non-prophylaxis group and one in the prophylaxis group, respectively. However, no difference in 30-day ICU mortality could be observed. Thirty-day CAPA incidence estimates were 1.4% (95% CI 0.2-9.7) in the MAFP group and 17.5% (95% CI 9.6-31.4) in the group without MAFP (p = 0.002). The respective subdistributional hazard ratio (sHR) for CAPA incidence comparing the MAFP versus no MAFP group was of 0.08 (95% CI 0.01-0.63; p = 0.017).
conclusionIn ICU patients with COVID-19 ARF, antifungal prophylaxis was associated with significantly reduced CAPA incidence, but this did not translate into improved survival. Randomized controlled trials are warranted to evaluate the efficacy and safety of MAFP with respect to CAPA incidence and clinical outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.