Risk factors associated with Covid-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort

Abstract

Objectives

The main objective of this study was to determine invasive pulmonary aspergillosis (IPA) incidence in the COVID-19 patients admitted to the intensive care unit (ICU), describe the patient characteristics associated with its occurrence and evaluate the impact on prognosis.

Methods

We conducted a retrospective cohort study including all successive COVID-19 patients hospitalized in four ICUs with secondary deterioration and ≥1 respiratory sample sent to the mycology department. A strengthened IPA testing strategy including seven mycological criteria was used. Patients were classified as probable IPA according to the EORTC/MSGERC classification if immunocompromised and to the recent COVID-19-associated IPA classification otherwise.

Results

Probable IPA was diagnosed in 21 out of the 366 COVID-19 patients (5.7%) admitted to the ICU and the 108 patients (19.4%) who underwent respiratory sampling for deterioration. No significant differences were observed between patients with and without IPA regarding age, gender, medical history and severity on admission and during hospitalization. Treatment with azithromycin for ≥3 days was associated with the diagnosis of probable IPA (odds ratio, 3.1; 95%-confidence interval, 1.1-8.5; p=0.02). A trend was observed with high dose dexamethasone and the occurrence of IPA. Overall mortality was higher in the IPA patients (15/21, 71.4% vs. 32/87, 36.8%; p<0.01).

Conclusion

IPA is a relatively frequent complication in severe COVID-19 patients responsible for increased mortality. Azithromycin, known to have immunomodulatory properties, may contribute to increase COVID-19 patient susceptibility to IPA.