High mortality and mechanical ventilation in COVID-19-associated pulmonary aspergillosis: insights from a two-center retrospective cohort study.

Background: Studies on COVID-19-associated pulmonary aspergillosis (CAPA) have raised concerns regarding its high mortality rates. This study aims to assess the mortality of CAPA caused by Alpha and Omicron variants among intensive care unit (ICU) patients in China. Methods: We enrolled 236 ICU patients admitted to Wuhan Huoshenshan Hospital from 4 January 2020, to 30 March 2022, during the Alpha variant epidemic, and 187 ICU patients admitted to Nanjing Jinling Hospital from 24 October 2022, to 19 January 2023, during the Omicron variant epidemic. We systematically collected clinical data for analysis, and all patients were confirmed to have SARS-CoV-2 infection through polymerase chain reaction (PCR) testing. Results: The incidence of CAPA was 5.1% (12/236) during the Alpha variant period and increased to 7.5% (14/187) during the Omicron variant period. The mortality rate among CAPA cases was 33.3% (4/12) for patients infected with the Alpha variant and 28.6% (4/14) for those infected with the Omicron variant. Both rates were higher than the mortality rates among patients without CAPA, which were 4.9% (11/224) during the Alpha period and 8.7% (15/173) during the Omicron period. Mechanical ventilation in CAPA patients requires careful consideration. Conclusion: Our findings emphasize the necessity of implementing more effective mycological detection methods and promoting internationally recognized diagnostic criteria for CAPA.