Abstract

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 registration The study was registered at ClinicalTrials.gov, number NCT04359693.

Details

Title
Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study
Author
Rouzé, Anahita; Lemaitre, Elise; Martin-Loeches, Ignacio; Povoa, Pedro; Diaz, Emili; Nyga, Rémy; Torres, Antoni; Metzelard, Matthieu; Damien Du Cheyron; Lambiotte, Fabien; Tamion, Fabienne; Labruyere, Marie; Claire Boulle Geronimi; Charles-Edouard Luyt; Nyunga, Martine; Pouly, Olivier; Thille, Arnaud W; Megarbane, Bruno; Saade, Anastasia; Magira, Eleni; Jean-François Llitjos; Ioannidou, Iliana; Alexandre, Pierre; 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; Pierre-Edouard Floch; Marois, Clémence; Ceccato, Adrian; Artigas, Antonio; Gaudet, Alexandre; Nora, David; Cornu, Marjorie; Duhamel, Alain; Labreuche, Julien; Nseir, Saad  VIAFID ORCID Logo  ; the coVAPid study group
Pages
1-14
Section
Research
Publication year
2022
Publication date
2022
Publisher
BioMed Central
ISSN
13648535
e-ISSN
1366609X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13054-021-03874-1
ProQuest document ID
2620935943
Copyright
© 2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.