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Background <p>Opportunistic infections such as cytomegalovirus (CMV) and COVID-19-associated pulmonary aspergillosis (CAPA) pose major risks in critically ill COVID-19 patients, particularly those receiving high-dose corticosteroids.</p> Methods <p>We conducted weekly active surveillance for CMV and Aspergillus in 210 ICU-admitted patients with severe COVID-19. Incidence, timing, and risk factors were assessed, with a focus on corticosteroid dose. Inverse probability of treatment weighting (IPTW)-adjusted logistic regression and Kaplan–Meier survival analyses were applied.</p> Results <p>CMV DNAemia (≥ 1000 copies/mL) occurred in 29.0% of patients, peaking during weeks 3–4. CAPA (possible + probable) occurred in 14.3% and peaked earlier, within the first two weeks. High-dose corticosteroid use was associated with significantly increased risks of CMV DNAemia (aOR 5.34; 95% CI, 2.69–10.58) and CAPA (aOR 2.28; 95% CI, 1.22–4.25).</p> Conclusion <p>CMV and CAPA occurred in distinct temporal patterns, with CMV reactivation peaking later in the ICU course. High-dose corticosteroids significantly increased the risk of both infections, underscoring the need for tailored surveillance strategies during intensive care.</p> Clinical trial number <p>Not applicable.</p>

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Active surveillance of cytomegalovirus and pulmonary aspergillosis in critically ill patients with COVID-19: risk assessment of high-dose steroids

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月21日

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  • Jung Soo Kim,
  • Dong Yeop Lee,
  • Se Ju Lee,
  • Ji Hyeon Baek,
  • Jin-Soo Lee,
  • Ah Jin Kim,
  • Hyung Keun Cha,
  • Dong Yoon Kang,
  • Jae Hyoung Im

摘要

Background

Opportunistic infections such as cytomegalovirus (CMV) and COVID-19-associated pulmonary aspergillosis (CAPA) pose major risks in critically ill COVID-19 patients, particularly those receiving high-dose corticosteroids.

Methods

We conducted weekly active surveillance for CMV and Aspergillus in 210 ICU-admitted patients with severe COVID-19. Incidence, timing, and risk factors were assessed, with a focus on corticosteroid dose. Inverse probability of treatment weighting (IPTW)-adjusted logistic regression and Kaplan–Meier survival analyses were applied.

Results

CMV DNAemia (≥ 1000 copies/mL) occurred in 29.0% of patients, peaking during weeks 3–4. CAPA (possible + probable) occurred in 14.3% and peaked earlier, within the first two weeks. High-dose corticosteroid use was associated with significantly increased risks of CMV DNAemia (aOR 5.34; 95% CI, 2.69–10.58) and CAPA (aOR 2.28; 95% CI, 1.22–4.25).

Conclusion

CMV and CAPA occurred in distinct temporal patterns, with CMV reactivation peaking later in the ICU course. High-dose corticosteroids significantly increased the risk of both infections, underscoring the need for tailored surveillance strategies during intensive care.

Clinical trial number

Not applicable.