ArticleEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Clinical spectrum of ICU-acquired invasive pulmonary aspergillosis according to SARS-CoV2 infection: a multicenter prospective cohort study.
Article in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundInvasive pulmonary aspergillosis (IPA) is a common cause of fungal infection acquired in intensive care unit (ICU) whose clinical landscape may differ according to SARS-CoV2 infection status.
methodWe included all mechanically ventilated patients hospitalized (≥ 48 h) participating in ICU of the REA-REZO network during a 6-year period. Among IPA patients, initial characteristics and outcomes were compared according to COVID-19. Additionally, to account for potential confounders, we performed an inverse probability of treatment weighting (IPTW). Rates of IPA were also compared according to SARS-CoV2 infection. Finally, we investigated risk factors associated with mortality among IPA patients using a Cox model regression.
resultsAmong 120 993 patients included during the study period, IPA was diagnosed in 254 patients. COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients were significantly older (median age 69 [62-73] years versus 63 [56-70] years; p < 0.001), less immunosuppressed (23.5% versus 32.4%; p = 0.001) and less severe at baseline (median SAPS II score 45 [35-54] versus 55 [39-65]; p < 0.001) compared to non-COVID-IPA patients. CAPA patients exhibited both a longer duration of mechanical ventilation (16 [9-33] days versus 8 [4-26] days; p = 0.002) and a longer ICU length of stay (LOS) (18 [10-38] days versus 14 [6-30] days, p = 0.015) after IPA diagnosis. However, survival did not differ according to COVID-19 status either in the raw population (log-rank test; p = 0.43) or after weighted Cox regression (HR 0.92 [95%CI 0.61-1.38]; p = 0.69). Incidence of IPA was higher in COVID-19 patients (incidence rate ratio: 8.45 [95%CI 6.59-10.87]; p < 0.001).
conclusionIn this large multicenter cohort, IPA had a similar impact on survival depending on SARS-CoV2 infection status. However, despite lower severity, CAPA patients experienced longer duration of mechanical ventilation and LOS.
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