Objective: Critically ill patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications, including invasive aspergillosis. Our study aimed to characterize the clinical significance and outcome of
Aspergillus species isolated from lower-respiratory-tract samples of critically ill OVID-19 patients at a single center.
Design: We conducted a retrospective cohort study to evaluate the characteristics of patients with COVID-19 and
aspergillus isolated from the lower respiratory tract and to identify predictors of outcomes in this population.
Setting: The setting was a single-center hospital system within the metropolitan Detroit region.
Results: The prevalence of
Aspergillus isolated in hospitalized COVID-19 patients was 1.18% (30/2461 patients), and it was 4.6% in critically ill ICU patients with COVID-19. Probable COVID-19-associated invasive pulmonary aspergillosis (CAPA) was found in 21 critically ill patients, and 9 cases were classified as colonization. The in-hospital mortality of critically ill patients with CAPA and those with
aspergillus colonization were high but not significantly different (76% vs. 67%,
p = 1.00). Furthermore, the in-hospital mortality for ICU patients with or without
Aspergillus isolated was not significantly different 73.3% vs. 64.5%, respectively (OR 1.53, CI 0.64–4.06,
p = 0.43). In patients in whom
Aspergillus was isolated, antifungal therapy (
p = 0.035, OR 12.3, CI 1.74–252); vasopressors (0.016, OR 10.6, CI 1.75–81.8); and a higher mSOFA score (
p = 0.043, OR 1.29 CI 1.03–1.72) were associated with a worse outcome. In a multivariable model adjusting for other significant variables, FiO
2 was the only variable associated with in-hospital mortality in patients in whom
Aspergillus was isolated (OR 1.07, 95% CI 1.01–1.27).
Conclusions: The isolation of
Aspergillus from lower-respiratory-tract samples of critically ill patients with COVID-19 is associated with high mortality. It is important to have a low threshold for superimposed infections such as CAPA in critically ill patients with COVID-19.
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