Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) emerged as important fungal complications in patients with COVID-19-associated severe acute respiratory failure (ARF). Whether mould active antifungal prophylaxis (MAFP) can prevent CAPA remains elusive so far. In this observational study, we included all consecutive patients admitted to intensive care units with COVID-19-associated ARF between September 1, 2020, and May 1, 2021. We compared patients with versus without antifungal prophylaxis with respect to CAPA incidence (primary outcome) and mortality (secondary outcome). Propensity score adjustment was performed to account for any imbalances in baseline characteristics. CAPA cases were classified according to European Confederation of Medical Mycology (ECMM)/International Society of Human and Animal Mycoses (ISHAM) consensus criteria. We included 132 patients, of whom 75 (57%) received antifungal prophylaxis (98% posaconazole). Ten CAPA cases were diagnosed, after a median of 6 days following ICU admission. Of those, 9 CAPA cases were recorded in the non-prophylaxis group and one in the prophylaxis group, respectively. However, no difference in 30-day ICU mortality could be observed. Thirty-day CAPA incidence estimates were 1.4% (95% CI 0.2–9.7) in the MAFP group and 17.5% (95% CI 9.6–31.4) in the group without MAFP (p = 0.002). The respective subdistributional hazard ratio (sHR) for CAPA incidence comparing the MAFP versus no MAFP group was of 0.08 (95% CI 0.01–0.63; p = 0.017). In ICU patients with COVID-19 ARF, antifungal prophylaxis was associated with significantly reduced CAPA incidence, but this did not translate into improved survival. Randomized controlled trials are warranted to evaluate the efficacy and safety of MAFP with respect to CAPA incidence and clinical outcomes.

中文翻译：

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用于预防危重患者 COVID-19 相关肺曲霉病的抗真菌预防：一项观察性研究

冠状病毒病 19 (COVID-19) 相关肺曲霉病 (CAPA) 成为 COVID-19 相关严重急性呼吸衰竭 (ARF) 患者的重要真菌并发症。迄今为止，霉菌主动抗真菌预防 (MAFP) 是否可以预防 CAPA 仍然难以捉摸。在这项观察性研究中，我们纳入了 2020 年 9 月 1 日至 2021 年 5 月 1 日期间因 COVID-19 相关 ARF 入住重症监护病房的所有连续患者。 ) 和死亡率（次要结果）。进行倾向评分调整以解释基线特征的任何不平衡。CAPA 病例根据欧洲医学真菌学联合会 (ECMM)/国际人类和动物真菌病学会 (ISHAM) 共识标准进行分类。我们纳入了 132 名患者，其中 75 名（57%）接受了抗真菌预防（98% 泊沙康唑）。在入住 ICU 后平均 6 天后，诊断出 10 例 CAPA 病例。其中，非预防组9例CAPA，预防组1例。然而，没有观察到 30 天 ICU 死亡率的差异。MAFP 组 30 天 CAPA 发生率估计值为 1.4%（95% CI 0.2-9.7），无 MAFP 组为 17.5%（95% CI 9.6-31.4）（p = 0.002）。比较 MAFP 组与无 MAFP 组的 CAPA 发生率的各个亚分布风险比 (sHR) 为 0.08（95% CI 0.01–0.63；p = 0.017）。在患有 COVID-19 ARF 的 ICU 患者中，抗真菌预防与显着降低 CAPA 发生率相关，但这并没有转化为提高生存率。有必要进行随机对照试验来评估 MAFP 在 CAPA 发生率和临床结果方面的有效性和安全性。