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COVID-19-associated Pulmonary Aspergillosis in Mechanically Ventilated Patients at 7 US Hospitals: Epidemiology and Estimated Likelihood of Invasive Pulmonary Aspergillosis—Results of the Prospective MSG-017 Study

Summary

A fungal infection caused by Aspergillus commonly occurs in COVID-19 patients on ventilators, affecting about 7% of cases. The study found that having this infection was linked to high death rates, but it was unclear whether the fungal infection itself or the severe COVID-19 caused the deaths. Single positive test results for the fungus are not reliable for diagnosis, and antifungal drugs did not improve survival rates.

Background

COVID-19-associated pulmonary aspergillosis (CAPA) is diagnosed by host factors, clinical findings, and mycologic tests, but current definitions do not effectively differentiate invasive aspergillosis (IPA) from colonization. There is no prospective US multicenter study of CAPA, and the validity of single mycologic test results remains unclear.

Objective

To determine the epidemiology, treatment, and outcomes of CAPA in US intensive care units, to estimate the likelihood of IPA among patients diagnosed with CAPA, and to compare different diagnostic definitions.

Results

CAPA incidence was 7% overall and 10% among patients with BAL testing. Seven percent had proven IPA, 79% had putative IPA, and 14% had unlikely IPA. Median estimated IPA likelihood was 30% across all CAPA cases. Single positive tests were insufficient for diagnosing CAPA-IPA, and CAPA mortality (71%) was not significantly impacted by antifungal treatment.

Conclusion

CAPA is associated with high mortality but IPA’s contribution is unclear. Single positive mycologic tests are insufficient for diagnosing CAPA-IPA. IPA likelihood is best estimated by combining multiple test results (both positive and negative) rather than relying on isolated positive findings.
  • Published in:Open Forum Infectious Diseases,
  • Study Type:Prospective Cohort Study,
  • Source: PMID: 40678324, DOI: 10.1093/ofid/ofaf331
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