Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study
Authors: Rouzé Anahita , Lemaitre Elise , Martin-Loeches Ignacio , Povoa Pedro , Diaz Emili , Nyga Rémy , Torres Antoni , Metzelard Matthieu , Du Cheyron Damien , Lambiotte Fabien , Tamion Fabienne , Labruyere Marie , Boulle Geronimi Claire , Luyt Charles-Edouard , Nyunga Martine , Pouly Olivier , Thille Arnaud W. , Megarbane Bruno , Saade Anastasia , Magira Eleni , Llitjos Jean-François , Ioannidou Iliana , Pierre Alexandre , Reignier Jean , Garot Denis , Kreitmann Louis , Baudel Jean-Luc , Voiriot Guillaume , Plantefeve Gaëtan , Morawiec Elise , Asfar Pierre , Boyer Alexandre , Mekontso-Dessap Armand , Makris Demosthenes , Vinsonneau Christophe , Floch Pierre-Edouard , Marois Clémence , Ceccato Adrian , Artigas Antonio , Gaudet Alexandre , Nora David , Cornu Marjorie , Duhamel Alain , Labreuche Julien , Nseir Saad ,   the coVAPid study group, Bouchereau Mathilde , Sendid Boualem , Boyd Sean , Coelho Luis , Maizel Julien , Cuchet Pierre , Zarrougui Wafa , Boyer Déborah , Quenot Jean-Pierre , Imouloudene Mehdi , de Chambrun Marc Pineton , Van Der Linden Thierry , Arrive François , Voicu Sebastian , Azoulay Elie , Moglia Edgard , Pene Frédéric , Cilloniz Catia , Thevenin Didier , Larrat Charlotte , Argaud Laurent , Guidet Bertrand , Turpin Matthieu , Contou Damien , Beurton Alexandra , Demiselle Julien , Meguerditchian David , Razazi Keyvan , Arrestier Romain , Tsolaki Vassiliki , Marzouk Mehdi , Brunin Guillaume , Weiss Nicolas , Morales Luis 
Published: January 2022

Background

Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients.

Objectives

To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients.

Methods

This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event.

Results

A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02,p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46,p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization.

Conclusions

Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia.

Clinical trial registrationThe study was registered at ClinicalTrials.gov, numberNCT04359693.