Antifungal concentrations in mechanically ventilated COVID-19 patients with or without ECMO: The CAPADOSE observational retrospective multicenter Study
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) is a major co-infection in critically ill patients and is linked to increased mortality. Critical illness and ECMO may affect antifungal pharmacokinetics, raising concerns about drug efficacy. This multicenter retrospective study included CAPA patients requiring mechanical ventilation in 20 intensive care units (ICUs) (March 2020 to November 2021), provided at least one antifungal blood level was available. The primary objective was to evaluate whether ECMO influenced the risk of subtherapeutic voriconazole levels. Secondary objectives included analyzing other antifungals and identifying risk factors for underdosing. Among 166 patients, 81 were on ECMO. A total of 358 voriconazole trough concentrations were collected in 150 patients. Subtherapeutic levels (<2 mg/L) were observed in 58 patients (39%) at first sampling and in 84 patients (56%) during the ICU stay, with no difference between ECMO and non-ECMO groups. No correlation was found between ECMO membrane duration and voriconazole levels. Daily dose was associated with low levels in univariate analysis only. Among 26 patients treated with isavuconazole, 11 (42%) had initial subtherapeutic levels. Renal replacement therapy, not ECMO, was associated with low isavuconazole levels (odds ratios = 7.5, P = 0.029). Over half of CAPA patients had subtherapeutic antifungal levels, but ECMO did not significantly influence drug exposure.
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BibTeX
@article{masi2026antifungal,
title = {{Antifungal concentrations in mechanically ventilated COVID-19 patients with or without ECMO: The CAPADOSE observational retrospective multicenter Study}},
author = {Paul Masi and Mickaël Lescroart and Anne Veinstein and Luc Desmedt and Luc Haudebourg and Julien Dessajan and Mathieu Lesouhaitier and Charles Verney and Juliette Chommeloux and Claire Roger and Elise Cuquemelle and Nicolas Dognon and Jean-Christophe Richard and Naim Jebnoun and Damien Du Cheyron and Hadrien Winiszewski and Sami Hraiech and Sophie Jacquier and Matthieu Petit and Hadrien Roze and Pascale Labedade and Arnaud W. Thille and Thomas Klein and Armand Mekontso-Dessap and Keyvan Razazi},
journal = {International Journal of Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1016/j.ijid.2025.107996},
url = {https://hal.science/hal-05802499v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Antifungal concentrations in mechanically ventilated COVID-19 patients with or without ECMO: The CAPADOSE observational retrospective multicenter Study
AU - Paul Masi
AU - Mickaël Lescroart
AU - Anne Veinstein
AU - Luc Desmedt
AU - Luc Haudebourg
AU - Julien Dessajan
AU - Mathieu Lesouhaitier
AU - Charles Verney
AU - Juliette Chommeloux
AU - Claire Roger
AU - Elise Cuquemelle
AU - Nicolas Dognon
AU - Jean-Christophe Richard
AU - Naim Jebnoun
AU - Damien Du Cheyron
AU - Hadrien Winiszewski
AU - Sami Hraiech
AU - Sophie Jacquier
AU - Matthieu Petit
AU - Hadrien Roze
AU - Pascale Labedade
AU - Arnaud W. Thille
AU - Thomas Klein
AU - Armand Mekontso-Dessap
AU - Keyvan Razazi
PY - 2026
DA - 2026/10/16
JO - International Journal of Infectious Diseases
DO - 10.1016/j.ijid.2025.107996
UR - https://hal.science/hal-05802499v1
AB - COVID-19-associated pulmonary aspergillosis (CAPA) is a major co-infection in critically ill patients and is linked to increased mortality. Critical illness and ECMO may affect antifungal pharmacokinetics, raising concerns about drug efficacy. This multicenter retrospective study included CAPA patients requiring mechanical ventilation in 20 intensive care units (ICUs) (March 2020 to November 2021), provided at least one antifungal blood level was available. The primary objective was to evaluate whether ECMO influenced the risk of subtherapeutic voriconazole levels. Secondary objectives included analyzing other antifungals and identifying risk factors for underdosing. Among 166 patients, 81 were on ECMO. A total of 358 voriconazole trough concentrations were collected in 150 patients. Subtherapeutic levels (<2 mg/L) were observed in 58 patients (39%) at first sampling and in 84 patients (56%) during the ICU stay, with no difference between ECMO and non-ECMO groups. No correlation was found between ECMO membrane duration and voriconazole levels. Daily dose was associated with low levels in univariate analysis only. Among 26 patients treated with isavuconazole, 11 (42%) had initial subtherapeutic levels. Renal replacement therapy, not ECMO, was associated with low isavuconazole levels (odds ratios = 7.5, P = 0.029). Over half of CAPA patients had subtherapeutic antifungal levels, but ECMO did not significantly influence drug exposure.
SN - 1201-9712
SN - 1878-3511
ER -