P-1032. Posaconazole for Prevention of COVID-19 Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients: the POSACOVID Study
Authors: Prattes Juergen , Giacobbe Daniele R , Marelli Cristina , Signori Alessio , Dettori Silvia , Cattardico Greta , Frost Jonas , Reizine Florian , Bassetti Matteo , Gangneux Jean-Pierre , Hoenigl Martin 
Published: January 2025

Abstract

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 1Demographic and clinical characteristics of patients after matching

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 1Matched cohorts after 1:1 and 1:1:1 matching. Both composed of 249 patients, although some different controls could have been selected.

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