High burden of COVID-19-associated pulmonary aspergillosis (CAPA) in severely immunocompromised patients requiring mechanical ventilation.

COVID-19-associated pulmonary aspergillosis (CAPA) is a frequent superinfection in critically ill COVID-19 patients and is associated with increased mortality. The increasing proportion of severely immunocompromised patients among COVID-19 patients who require mechanical ventilation warrants research into the incidence and impact of CAPA during the vaccination era. We performed a retrospective, monocentric, observational study. We collected data from adult patients with severe COVID-19 requiring mechanical ventilation admitted to the ICU of University Hospitals Leuven, a tertiary referral center, between March 1st, 2020 and November 14th, 2022. Diagnosis of probable or proven CAPA was made according to the 2020 ECMM/ISHAM criteria. We included 335 patients. Bronchoalveolar lavage (BAL) sampling was performed in 300 (90%) patients. CAPA was diagnosed in 112 (33%) patients. CAPA incidence was 62% (50/81 patients) in EORTC/MSGERC host factor positive patients, compared to 24% (62/254) in host factor negative patients. CAPA incidence was significantly higher in the vaccination era, increasing from 24% (57/241) to 59% (55/94) in patients admitted to ICU before and since October 2021 respectively. Both EORTC/MSGERC host factors and ICU admission in the vaccination era were independently associated with CAPA development. CAPA remained an independent risk factor associated with mortality during the vaccination era. Presence of EORTC/MSGERC host factors for invasive mold disease is associated with increased CAPA incidence and worse outcome parameters, and is the main driver for the significantly higher incidence of CAPA in the vaccination era. Our findings warrant investigation of antifungal prophylaxis in critically ill COVID-19 patients.

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.