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. 2026 Jan 12.
doi: 10.1007/s10096-025-05391-3. Online ahead of print.

Clinical spectrum of ICU-acquired invasive pulmonary aspergillosis according to SARS-CoV2 infection: a multicenter prospective cohort study

Florian Reizine  1 , Mattéo Mauget  2 , Nicolas Massart  3 , Yannick Fedun  4 , Anaïs Machut  5 , Charles-Hervé Vacheron  5   6   7 , Anne Savey  5   7 , Arnaud Friggeri  5   6   7 , Alain Lepape  5   6   7 ; REAREZO study group
Collaborators, Affiliations

Clinical spectrum of ICU-acquired invasive pulmonary aspergillosis according to SARS-CoV2 infection: a multicenter prospective cohort study

Florian Reizine et al. Eur J Clin Microbiol Infect Dis. .

Abstract

Background: Invasive 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.

Method: We 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.

Results: Among 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).

Conclusion: In 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.

Keywords: COVID-19; ICU; Invasive pulmonary aspergillosis.

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Conflict of interest statement

Declarations. Ethical considerations: All patients received specific information about the potential use of their personal data for research purposes and were given the opportunity to refuse it. The study was carried out in accordance with the ethical standards of the Declaration of Helsinki, and the database was approved by the National Data Protection Commission (Commission nationale de l'informatique et des libertés, Number 919149) and by the institutional review board (CPP SUD ESTdIRB 00009118). Competing interests: The authors declare no competing interests.

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