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Background <p>Invasive pulmonary aspergillosis (IPA) is a common cause of fungal infection acquired in intensive care unit (ICU) whose clinical landscape may differ according to SARS-CoV2 infection status.</p> Method <p>We included all mechanically ventilated patients hospitalized (≥ 48&#xa0;h) participating in ICU of the REA-REZO network during a 6-year period. Among IPA patients, initial characteristics and outcomes were compared according to COVID-19. Additionally, to account for potential confounders, we performed an inverse probability of treatment weighting (IPTW). Rates of IPA were also compared according to SARS-CoV2 infection. Finally, we investigated risk factors associated with mortality among IPA patients using a Cox model regression.</p> Results <p>Among 120 993 patients included during the study period, IPA was diagnosed in 254 patients. COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients were significantly older (median age 69 [62–73] years versus 63 [56–70] years; <i>p</i> &lt; 0.001), less immunosuppressed (23.5% versus 32.4%; <i>p</i> = 0.001) and less severe at baseline (median SAPS II score 45 [35–54] versus 55 [39–65]; <i>p</i> &lt; 0.001) compared to non-COVID-IPA patients. CAPA patients exhibited both a longer duration of mechanical ventilation (16 [9–33] days versus 8 [4–26] days; <i>p</i> = 0.002) and a longer ICU length of stay (LOS) (18 [10–38] days versus 14 [6–30] days, <i>p</i> = 0.015) after IPA diagnosis. However, survival did not differ according to COVID-19 status either in the raw population (log-rank test; <i>p</i> = 0.43) or after weighted Cox regression (HR 0.92 [95%CI 0.61–1.38]; <i>p</i> = 0.69). Incidence of IPA was higher in COVID-19 patients (incidence rate ratio: 8.45 [95%CI 6.59–10.87]; <i>p</i> &lt; 0.001).</p> Conclusion <p>In this large multicenter cohort, IPA had a similar impact on survival depending on SARS-CoV2 infection status. However, despite lower severity, CAPA patients experienced longer duration of mechanical ventilation and LOS.</p>

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Clinical spectrum of ICU-acquired invasive pulmonary aspergillosis according to SARS-CoV2 infection: a multicenter prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年1月12日

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  • Florian Reizine,
  • Mattéo Mauget,
  • Nicolas Massart,
  • Yannick Fedun,
  • Anaïs Machut,
  • Charles-Hervé Vacheron,
  • Anne Savey,
  • Arnaud Friggeri,
  • Alain Lepape,
  • Melissa Abbes,
  • Abdelkrim Abdelmalek,
  • Francoise Adema,
  • Serge Alfandari,
  • Alexandra Allaire,
  • Antonio Alvarez,
  • Nacim Ammenouche,
  • Laurent Argaud,
  • Philippe Aries,
  • Gérard Audibert,
  • Caroline Aurel,
  • Odile Bajolet,
  • Frédéric Barbut,
  • Geneviève Barjon,
  • Magali Bauer Grandpierre,
  • Patricia Baune,
  • Sebastien Beague,
  • Bassam Beilouny,
  • Nicolas Bele,
  • Nicolas Belin,
  • Cécile Bernerd,
  • Yasmina Berrouane,
  • Aziz Berrouba,
  • Julie Bertrand,
  • Claire Bianchi,
  • Sandrine Biangoma,
  • Fabienne Birot Jaulin,
  • Romain Blanchon,
  • Julien Bohe,
  • Severine Bonjean,
  • Michel Bonnivard,
  • Stéphanie Bordes-couecou,
  • Abdenour Bouhara,
  • Philippe Bouillard,
  • Nicolas Boulet,
  • Amine Bouriga,
  • Céline Bourigault,
  • Sylvie Bourzeix,
  • Nicolas Boussekey,
  • Mathieu Boutonnet,
  • Sébastien Boutreux,
  • Hanene Bouzidi,
  • Julie Brochart,
  • Stephanie Bulyez,
  • Laurianne Buyer,
  • Marie Callanquin,
  • Nathalie Canu,
  • Morgan Caplan,
  • Matthieu Capron,
  • Daniel Carbognani,
  • Vincent Castelain,
  • Vincent Catanese,
  • Isabelle Cattaneo,
  • Cyril Charron,
  • Vanessa Chartier,
  • Guillaume Chassaing,
  • Robert Chausset,
  • Olivia Cherel,
  • Fabrice Chopin,
  • Catherine Chubilleau,
  • Céline Clayer,
  • Sylvie Comparot,
  • Philippe Corne,
  • Marie-Elisabeth Cornesse,
  • Gaelle Corno,
  • Esther Cortes,
  • Gaëlle Cosmao,
  • Patricia Courouble,
  • Christian Crombe,
  • Véronique Curnier,
  • Caroline Cyvoct,
  • Monzer Dabbachi,
  • Abla Daroukh,
  • Damien Dassant,
  • Martine Daumas,
  • Aurélien Daurat,
  • Nathalie De Gevigney,
  • Stephane De Rudnicki,
  • Karim Debbat,
  • Dominique Deffarges,
  • Fanny Delanghe,
  • Olivier Delastre,
  • Célia Deletage,
  • Joel Delhomme,
  • Jean Paul Délias,
  • Martine Delorme,
  • Fabienne Derramond,
  • Geraldine Dessertaine,
  • Isabelle Dijols,
  • Kamel Djedaini,
  • Loïc Dopeux,
  • Claudia Douat Beyries,
  • Denis Doyen,
  • Margaux Duboin,
  • Jean-Louis Dubost,
  • Sophie Duhoo,
  • Thierry Dulac,
  • Julien Dupeyrat,
  • Clarisse Dupin,
  • Laurène Dupont,
  • Matthieu Duprey,
  • Michel Durand,
  • Isabelle Durand Joly,
  • Jean-Yves Dusseau,
  • Pierre Yves Egreteau,
  • Carole Eldin,
  • Christelle Elias,
  • Florence Espinasse,
  • Valerie Failla,
  • Eric Farfour,
  • Abdelhamid Fatah,
  • Luis Ferreira,
  • Veronique Fidji,
  • Pierre Fillatre,
  • Toufic Finge,
  • Véronique Fleurial,
  • Arnaud Florentin,
  • Candice Fontaine,
  • Agnès Fribourg,
  • Claude Galland,
  • Richard Galliot,
  • Sylvain Garnier,
  • Gaelle Gasan,
  • Julien Gaubert-duclos,
  • Valérie Gauzere,
  • Thomas Geffriaud,
  • Isabelle Geneau,
  • Hughes Georges,
  • Solweig Gerbier Colomban,
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  • Sébastien Gibot,
  • Audrey Glanard,
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  • Marieline Goret,
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  • Florence Gourdon,
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  • Alexandre Herbland,
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  • Hervé Hyvernat,
  • Alexandra Jean,
  • Asma Jeblaoui,
  • Boris Jolibois,
  • Sylvie Joron,
  • Gautier Julien,
  • Dominique Jusserand,
  • Michel Kaidomar,
  • Djedaini Kamel,
  • Françoise Karnycheff,
  • Jean Kempf,
  • Lyes Knani,
  • Béatrice La Combe,
  • Marie Labruyere,
  • Sandrine Lacroix,
  • Bruno Lafon,
  • Katia Lamant,
  • Caroline Landelle,
  • Peggy Larroudé,
  • laurence Lattes,
  • Anne Launoy,
  • Thierry Lavigne,
  • Christine Lawrence,
  • Quoc Vien Le,
  • Muriel Le Coq,
  • Anne-Sophie Le Floch,
  • Fanny Le Gall,
  • Guillaume Le Loup,
  • Marie Lecornier,
  • Lucie Lecoutre,
  • Marion Lecuru,
  • Stanislas Ledochowski,
  • Montaine Lefebvre,
  • Philippe Lehoux,
  • Stephane Lelimouzin,
  • Florence Lemann,
  • Rusel Leon,
  • Claire Lepouse,
  • Thomas Lescot,
  • Mélanie Levrard,
  • Marie Laure Lier,
  • Anne Lignereux,
  • Aurore Loquet,
  • Benjamin Louart,
  • Quentin Maestraggi,
  • Claire Maheu,
  • Aurélie Maindron,
  • Francois Mallard,
  • Marie Reine Mallaret,
  • Bernard Mankikian,
  • Christiane Manzon,
  • Philippe Mardrus,
  • Jacques Mariot,
  • Benoit Marot,
  • Maelle Martin,
  • Audrey Martin,
  • Emmanuelle Martin,
  • Olivier Martinet,
  • Pascale Martres,
  • Clément Masse,
  • Catherine-Cecile Mauranne,
  • Virginie Maxime,
  • Karim Merouani,
  • Michael Mervant,
  • Olivier Meunier,
  • Ella-Pauline Meyer,
  • Ferhat Meziani,
  • Salman Mohammad,
  • Martin Mombrun,
  • Laure Mons,
  • Sébastien Moschietto,
  • Bruno Mourvillier,
  • Céline Muller,
  • Elodie Munier-marion,
  • Jean-Christophe Navellou,
  • Caroline Neulier,
  • François Nicolas,
  • Dominique Nicollon,
  • Jacques-Yves Nizou,
  • Abdelali Ouchikhe,
  • Olivier Pajot,
  • Michel Pascal,
  • Olivier Passouant,
  • René-Gilles Patrigeon,
  • Frédérique Pavillard,
  • Christophe Perdrix,
  • Johana Perez,
  • Romain Persichini,
  • Jean-Sebastien Petit,
  • Walter Picard,
  • Sylvie Picault,
  • Santiago Picos Gil,
  • Jérôme Pillot,
  • Patrick Pina,
  • Blandine Placet,
  • Gaëtan Plantefeve,
  • Rémi Plattier,
  • Laurent Poiron,
  • Christian Pommier,
  • Gaël Pradel,
  • Cristian Prelipcean,
  • Paul-Simon Pugliesi,
  • Vincent Quenee,
  • Julie Racaud,
  • Celine Ragot,
  • Tantely Randriamandrato,
  • Olga Raposo,
  • Eve Remy,
  • Laeticia Renard,
  • Gaelle Ribeyre,
  • Jean-Christophe Richard,
  • Sylvie Ricome,
  • Thomas Rimmele,
  • Carole Rimpici,
  • Audrey Robin,
  • Adrien Robine,
  • Isabel Roca-cerezo,
  • Anne-Claude Roche,
  • Laetitia Rohr,
  • Gwenaël Rolland-jacob,
  • Antoine Romen,
  • Adrien Roques,
  • Catherine Rougier,
  • Stéphane Rouleau,
  • Jérôme Roustan,
  • Laysa Saadi,
  • Mélanie Saint-leger,
  • Florence Saint-orens,
  • Faouzi Saliba,
  • Maleka Schenck,
  • Frédérique Schoertgen,
  • Dominique Sechaud,
  • Nicholas Sedillot,
  • Arnaud Sement,
  • Amine Si-ali,
  • Catherine Simac,
  • Georges Simon,
  • Michel Sirodot,
  • Aude Spitz,
  • Magdalena Szczot,
  • Philippe Tagawa,
  • Marine Tasle,
  • Bertrand Texier,
  • Fabrice Thiollière,
  • Benoit Thiphagne,
  • Aurélie Thomas-hervieu,
  • François Tinturier,
  • Alexandre Tonnelier,
  • Alexandre Toro,
  • David Tranvan,
  • Dominique Trivier,
  • Rémi Trusson,
  • Lionel Ursulet,
  • Marie-Laure Valdeyron,
  • Catherine Vallet,
  • Vanessa Van Rossem,
  • Laurence Vasse,
  • Myriam Venelle,
  • Christine Venot,
  • Franck Verdonk,
  • Antoine Vieillard-baron,
  • Jean-François Vincent,
  • Michel Vitris,
  • Emmanuel Vivier,
  • Florent Wallet,
  • Hussein Yassine,
  • Lassane Zanre,
  • Noemie Zucman,
  • Cecile Zylberfajn

摘要

Background

Invasive pulmonary aspergillosis (IPA) is a common cause of fungal infection acquired in intensive care unit (ICU) whose clinical landscape may differ according to SARS-CoV2 infection status.

Method

We included all mechanically ventilated patients hospitalized (≥ 48 h) participating in ICU of the REA-REZO network during a 6-year period. Among IPA patients, initial characteristics and outcomes were compared according to COVID-19. Additionally, to account for potential confounders, we performed an inverse probability of treatment weighting (IPTW). Rates of IPA were also compared according to SARS-CoV2 infection. Finally, we investigated risk factors associated with mortality among IPA patients using a Cox model regression.

Results

Among 120 993 patients included during the study period, IPA was diagnosed in 254 patients. COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients were significantly older (median age 69 [62–73] years versus 63 [56–70] years; p < 0.001), less immunosuppressed (23.5% versus 32.4%; p = 0.001) and less severe at baseline (median SAPS II score 45 [35–54] versus 55 [39–65]; p < 0.001) compared to non-COVID-IPA patients. CAPA patients exhibited both a longer duration of mechanical ventilation (16 [9–33] days versus 8 [4–26] days; p = 0.002) and a longer ICU length of stay (LOS) (18 [10–38] days versus 14 [6–30] days, p = 0.015) after IPA diagnosis. However, survival did not differ according to COVID-19 status either in the raw population (log-rank test; p = 0.43) or after weighted Cox regression (HR 0.92 [95%CI 0.61–1.38]; p = 0.69). Incidence of IPA was higher in COVID-19 patients (incidence rate ratio: 8.45 [95%CI 6.59–10.87]; p < 0.001).

Conclusion

In this large multicenter cohort, IPA had a similar impact on survival depending on SARS-CoV2 infection status. However, despite lower severity, CAPA patients experienced longer duration of mechanical ventilation and LOS.