Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53–7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88–5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693 .

中文翻译：

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SARS-CoV-2 或流感肺炎插管患者中的侵袭性肺曲霉病：一项欧洲多中心比较队列研究

最近的多中心研究确定 COVID-19 是侵袭性肺曲霉病 (IPA) 的危险因素。然而，尚无大型多中心研究比较 COVID-19 和流感患者之间的 IPA 发病率。与流感患者相比，确定危重 SARS-CoV-2 患者中假定的 IPA 发生率。本研究是一项计划对 coVAPid 多中心回顾性欧洲队列进行的辅助分析。因 SARS-CoV-2 肺炎或流感肺炎而连续需要有创机械通气 > 48 小时的成年患者被纳入其中。根据 Blot 定义，假定的 IPA 28 天累积发生率是主要结果。IPA 发生率使用 Kalbfleisch 和 Prentice 方法进行估计，将 28 天内拔管（死亡或活着）视为竞争事件。总共纳入 1047 名患者（SARS-CoV-2 组 566 名，流感组 481 名）。SARS-CoV-2 肺炎组中推定的 IPA 发生率（14 例，2.5%）低于流感肺炎组（29 例，6%），调整后的病因特异性风险比 (cHR) 3.29 (95% CI 1.53–7.02) ，p = 0.0006）。当假定的 IPA 和曲霉菌呼吸道定植结合起来时，与流感组相比，SARS-CoV-2 组的发病率也显着降低（4.1% vs. 10.2%），调整后的 cHR 3.21（95% CI 1.88-5.46） ，p < 0.0001）。在整个研究人群中，与定植患者或未定植 IPA 或曲霉菌的患者相比，假定的 IPA 与 28 天死亡率和 ICU 住院时间显着增加相关。总体而言，假定的 IPA 发生率较低。SARS-CoV-2肺炎患者的发病率明显低于流感肺炎患者。临床试验注册 该研究在 ClinicalTrials.gov 上注册，注册号为 NCT04359693。