# P-1032. Posaconazole for Prevention of COVID-19 Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients: the POSACOVID Study

Juergen Prattes, Daniele Roberto Giacobbe, Cristina Marelli, Alessio Signori, Silvia Dettori, Greta Cattardico, Jonas Frost, Florian Reizine, Matteo Bassetti, Jean-Pierre Gangneux, et al.

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## To cite this version:

Juergen Prattes, Daniele Roberto Giacobbe, Cristina Marelli, Alessio Signori, Silvia Dettori, et al. P-1032. Posaconazole for Prevention of COVID-19 Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients: the POSACOVID Study. Open Forum Infectious Diseases, 2025, 12 (Supplement_1), pp.ofae631.1222. 10.1093/ofid/ofae631.1222. hal-05313352

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Submitted on 14 Oct 2025

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Abstract citation ID: ofae631.1222

P-1032. Posaconazole for Prevention of COVID-19 Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients: the POSACOVID Study

Juergen Prattes, MD, PhD¹; Daniele R. Giacobbe, M.D.²; Cristina Marelli, BS³; Alessio Signori, PhD²; Silvia Dettori, MD²; Greta Cattardico, MD²; Jonas Frost, MD¹; Florian Reizine, MD⁴; Matteo Bassetti, PhD⁵; Jean-Pierre Gangneux, Prof.⁴; Martin Hoenigl, MD⁶; ¹Medical University of Graz, Graz, Steiermark, Austria; ²University of Genoa, Genoa, Liguria, Italy; ³IRCCS Ospedale Policlinico San Martino, Genoa, Liguria, Italy; ⁴University of Rennes, Rennes, Bretagne, France; ⁵Department of Health Science (DISSAL), Infectious Diseases Unit., Genova, Liguria, Italy; ⁶Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria, Graz, Steiermark, Austria

**Study Group:**

**Session:** 137. Medical Mycology

Friday, October 18, 2024: 12:15 PM

**Background.** The relative number of COVID-19 patients developing COVID-19 associated pulmonary aspergillosis (CAPA) has been increasing within the vaccination area and mortality is still high. This study investigated the impact of posaconazole (POSA) prophylaxis in COVID-19 patients with acute respiratory failure receiving corticosteroids on the risk for development of CAPA.

<table><caption>**Table 1** Demographic and clinical characteristics of patients after matching</caption><thead><tr><th>Variable<sup>*</sup></th><th>Center 1<br>(n = 800)</th><th>Center 2<br>(n = 800)</th><th>Center 3<br>(n = 800)</th><th>P<br>(center 1 vs. 2)</th><th>P<br>(center 2 vs. 3)</th></tr></thead><tbody><tr><td>Posaconazole prophylaxis</td><td>83 (80.00)</td><td>83 (80.00)</td><td>83 (80.00)</td><td>4.8865</td><td>0</td></tr><tr><td>Age at COVID admission in patients, median (IQR)<sup>**</sup></td><td>63 (58-71)</td><td>63 (59-72)</td><td>63 (57-71)</td><td>0.0000</td><td>0.5332</td></tr><tr><td>Weight (kg)<sup>**</sup></td><td>64 (59-70)</td><td>64 (59-70)</td><td>63 (59-70)</td><td>0.0000</td><td>0.2060</td></tr><tr><td>EDP/TC/NB/SECR risk factor present at EDZ admission<sup>**</sup></td><td>8 (8.00)</td><td>9 (8.00)</td><td>9 (8.00)</td><td>0.0000</td><td>0.1000</td></tr><tr><td>EDP/TC/NB/SECR</td><td>3 (3.00)</td><td>3 (2.00)</td><td>3 (2.00)</td><td>0.0000</td><td>0.6000</td></tr><tr><td>Treatment with tocilizumab<sup>**</sup></td><td>3 (3.00)</td><td>3 (2.00)</td><td>3 (2.00)</td><td>0.0000</td><td>0.5000</td></tr><tr><td>Systemic oral treatment</td><td>83 (80.00)</td><td>83 (80.00)</td><td>83 (80.00)</td><td>-</td><td>0</td></tr><tr><td>Time at risk in days, median (IQR)<sup>**</sup></td><td>13 (10-20)</td><td>13 (10-20)</td><td>13 (10-20)</td><td>-</td><td>0</td></tr></tbody><tfoot><tr><td colspan="6"><sup>*</sup>Supplement is in italics, unless otherwise indicated</td></tr><tr><td colspan="6"><sup>**</sup>Meeting criteria</td></tr><tr><td colspan="6">*Production of relevant images (EDZ for center 1, EDZ for center 2, EDZ for center 3)</td></tr></tfoot></table>

**Methods.** The primary aim of this prospective, multicenter, case-control study was to assess whether application of POSA prophylaxis in mechanically ventilated COVID-19 patients reduces the risk for CAPA development. All consecutive patients from center 1 (cases) who received POSA prophylaxis as standard-of-care were matched to one subject from center 2 and center 3 who did not receive any antifungal prophylaxis (Figure 1), using propensity score matching for the following variables: (i) age; (ii) sex; (iii) treatment with tocilizumab; (iv) time at risk.

<figure><img src="image_3.png" /><figcaption>**Figure 1** Matched cohorts after 1:1 and 1:1:1 matching. Both composed of 249 patients, although some different controls could have been selected.</figcaption></figure>

**Results.** Eighty-three consecutive patients receiving POSA were identified at center 1 and matched to 166 controls (Table 1). The pre-matching CAPA incidence rates were 1.69 CAPA/1000 ICU days in center 1, 1.42 CAPA/1000 ICU days in center 2 and 9.53 CAPA/1000 ICU days in center 3. The CAPA incidence rate ratio before matching was 2.38 (95% CI 0.87–9.08; p = 0.072) for those not receiving prophylaxis versus those who did. In post-matching multivariable logistic regression, presence of an EORTC/MSG risk factor at ICU admission (OR 4.35) and Center (Center 3 versus 1: OR 6.07; 95% CI 1.76 – 20.91; p = 0.004; Center 2 versus 1: not significant) were associated with CAPA development.

**Conclusion.** The impact of POSA prophylaxis depends on the baseline CAPA incidence rate, which varies widely between centers and underlying individual patient risk factors. Future trials should therefore investigate targeted antifungal prophylaxis in COVID-19 patients.

**Disclosures.** Juergen Prattes, MD, PhD, AbbVie Inc.: Stocks/Bonds (Private Company)[Gilead: Honoraria|MSD: Grant/Research Support|Novo Nordisk: Stocks/Bonds (Private Company)|Pfizer: Grant/Research Support|Pfizer: Honoraria
Daniele R. Giacobbe, M.D., bioMerieux: Grant/Research Support|Gilead Italia: Grant/Research Support|Menarini: Honoraria|Pfizer: Grant/Research Support|Pfizer: Honoraria|Shionogi: Grant/Research Support|Tillotts Pharma: Advisor/Consultant Matteo Bassetti, PhD, Angelini: Advisor/Consultant|Angelini: Honoraria|Astellas: Advisor/Consultant|Astellas: Honoraria|bioMerieux: Advisor/Consultant|bioMerieux: Honoraria|Cidara: Advisor/Consultant|Cidara: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|Menarini: Advisor/Consultant|Menarini: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Nabriva: Advisor/Consultant|Nabriva: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Tetraphase: Advisor/Consultant|Tetraphase: Honoraria Jean-Pierre Gangneux, Prof., Gilead: Honoraria|MundiPharma: Advisor/Consultant|MundiPharma: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria Martin Hoenigl, MD, Aicuris: Advisor/Consultant|Astra Zeneca: Honoraria|Gilead: Grant/Research Support|Gilead: Honoraria|IMMY: Grant/Research Support|Melinta: Grant/Research Support|Melinta: Honoraria|MSD: Grant/Research Support|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Pfizer: Grant/Research Support|Pulmocide: Advisor/Consultant|Pulmocide: Grant/Research Support|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Shionogi: Honoraria