Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study

Abstract

Background: Recent multicenter studies identifed 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 infuenza patients. Objectives: To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with infuenza patients. Methods: This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Con‑ secutive adult patients requiring invasive mechanical ventilation for>48 h for SARS-CoV-2 pneumonia or infuenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot defnition, was the primary outcome. IPA incidence was estimated using the Kalbfeisch 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 infuenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in infuenza pneumonia group (29, 6%), adjusted cause-specifc 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 signifcantly lower in the SARS-CoV-2 group, as compared to infuenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88-5.46, p<0.0001). In the whole