Influenza was recently reported as a risk factor for invasive aspergillosis (IA). We aimed to describe prognostic factors for influenza-associated IA (IAA) and poor outcome and mortality in critically ill patients in Switzerland. All adults with confirmed influenza admitted to the ICU at two Swiss tertiary care centres during the 2017/2018 influenza season were retrospectively evaluated. IAA was defined by clinical, mycological and radiological criteria: a positive galactomannan in bronchoalveolar lavage or histopathological or cultural evidence in respiratory specimens of Aspergillus spp., any radiological infiltrate and a compatible clinical presentation. Poor outcome was defined as a composite of in-hospital mortality, ICU length of stay (LOS), invasive ventilation for > 7 days or extracorporeal membrane oxygenation. Of 81 patients with influenza in the ICU, 9 (11%) were diagnosed with IAA. All patients with IAA had poor outcome compared to 26 (36%) patients without IAA (p < 0.001). Median ICU-LOS and mortality were 17 vs. 3 days (p < 0.01) and 3/9 (33%) vs. 13/72 (18%; p = 0.37) in patients with vs. without IAA, respectively. Patients with IAA had significantly longer durations of antibiotic therapy, vasoactive support and mechanical ventilation. Aspergillus was the most common respiratory co-pathogen (9/40, 22%) followed by classical bacterial co-pathogens. IAA was not associated with classical risk factors. Aspergillus is a common superinfection in critically ill influenza patients associated with poor outcome and longer duration of organ supportive therapies. Given the absence of classical risk factors for aspergillosis, greater awareness is necessary, particularly in those requiring organ supportive therapies.

中文翻译：

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重症患者流感相关曲霉病——一项回顾性双中心队列研究。

流感最近被报道为侵袭性曲霉病 (IA) 的危险因素。我们旨在描述瑞士流感相关 IA (IAA) 的预后因素以及危重患者的不良预后和死亡率。回顾性评估了 2017/2018 年流感季节期间在两个瑞士三级医疗中心入住 ICU 的所有确诊流感成人。IAA 由临床、真菌学和放射学标准定义：支气管肺泡灌洗液中半乳甘露聚糖阳性或曲霉属呼吸道标本中的组织病理学或文化证据、任何放射学浸润和相容的临床表现。不良结局定义为院内死亡率、ICU住院时间（LOS）、有创通气> 7天或体外膜肺氧合。在 ICU 的 81 名流感患者中，9 名 (11%) 被诊断为 IAA。与没有 IAA 的 26 名 (36%) 患者相比，所有 IAA 患者的预后较差 (p < 0.001)。有 IAA 与无 IAA 患者的中位 ICU-LOS 和死亡率分别为 17 天和 3 天（p < 0.01）和 3/9（33%）和 13/72（18%；p = 0.37）。IAA 患者的抗生素治疗、血管活性支持和机械通气的持续时间显着延长。曲霉是最常见的呼吸道共病原体 (9/40, 22%)，其次是经典的细菌共病原体。IAA 与经典危险因素无关。曲霉菌是危重流感患者中常见的二重感染，与较差的结果和较长的器官支持治疗持续时间有关。鉴于没有曲霉病的经典危险因素，