ArticleBMC infectious diseases2026
Invasive pulmonary aspergillosis among ICU patients with COVID-19, influenza, and preexisting host factors: a nationwide cohort study.
Article in BMC infectious diseases, 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
backgroundPrevious studies on the association between coronavirus disease 2019 (COVID-19) and invasive pulmonary aspergillosis (IPA) were limited by their single-center nature and small patient population. Whether aspergillosis risk is related to COVID-19 or other factors remains unclear. This study aimed to determine whether COVID-19 among intensive care unit (ICU) patients is associated with an increased incidence of IPA compared with that among individuals with influenza or preexisting host factors (control).
methodsThis was a nationwide study performed using the Korean National Health Insurance Service database. A cohort of 28,089 patients with COVID-19 (2020-2022), 9993 individuals with influenza (2015-2019), and 11,807 control patients (2015-2019) were analyzed. Odds ratios (ORs) and 95% confidence intervals (CIs) of outcomes were calculated between the propensity score-matched groups.
resultsAfter matching, patients with COVID-19 were paired with 9649 patients with influenza (mean [SD] age, 72.7 [15.1] years vs. 72.7 [14.5] years; men, 53.3% vs. 52.2%) and 5709 control patients (mean [SD] age, 71.8 [12.0] years vs. 72.2 [11.1] years; men, 70.0% vs. 72.2%). The COVID-19 group was not associated with an increased risk of IPA compared to the observations in the influenza (OR, 1.20; 95% CI 0.97-1.48) or the control (OR, 1.06; 95% CI 0.89-1.26) group. Consistent findings were observed for patients receiving high-flow nasal cannula or mechanical ventilation. The risk factors for IPA included male sex, chronic pulmonary disease, chronic liver disease, admission to higher-volume hospitals, renal replacement therapy, and length of hospital stay; COVID-19 was not implicated (COVID-19 vs. influenza; adjusted OR, 1.22; 95% CI 0.97-1.54 and COVID-19 vs. control; adjusted OR, 1.17; 95% CI 0.97-1.42). In the COVID-19 group, corticosteroid use for ≥ 7 days was associated with an increased risk of IPA, regardless of the dosage.
conclusionsICU patients with COVID-19 were not at an increased risk of IPA compared to those with influenza or preexisting host factors. COVID-19 may not predispose to IPA.
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