Effects of Antifungal Treatment in COVID-19-Associated Pulmonary Aspergillosis A European Multicenter Cohort Study
Abstract
BACKGROUND: The management of COVID-19-associated invasive aspergillosis (CAPA) is still debated while cases continue to occur, and more and more frequently in vulnerable populations, stressing the importance of obtaining data on the treatment of this disease. Only small cohort studies and case reports have yet discussed this essential issue, and the data obtained are insufficient to make conclusions with confidence. RESEARCH QUESTION: Is antifungal treatment associated with lower 60-day mortality in patients with probable or proven CAPA? STUDY DESIGN AND METHODS: This study assessed the association of antifungal treatment with 60-day mortality for probable/proven CAPA cases from a French multicenter study and all consecutive CAPA cases (after 2020) from ICUs of 5 major European centers. Patients were compared according to antifungal treatment. Survival analysis was conducted by using Cox regression analysis and inverse probability of treatment weighting based on a propensity score. RESULTS: In total, 259 patients with CAPA were included, 237 (91.5%) receiving antifungals for CAPA (215 [90.7%] of whom received azole antifungal drugs). Baseline characteristics were similar between patients who received antifungals and those who did not. Age (hazard ratio [HR], 1.02; 95% CI, 1.00-1.04; P = .048), immunosuppressive treatment (HR, 2.08; 95% CI, 1.12-3.41; P < .001), and remdesivir administration (HR, 1.96; 95% CI, 1.12-3.41; P = .018) were independently associated with increased 60-day mortality according to Cox regression analysis in the raw population. Male sex (HR, 0.61; 95% CI, 0.40-0.95; P = .024) and antifungal treatment (HR, 0.31; 95% CI, 0.17-0.59; P < .001) were associated with lower 60-day mortality. Cox-weighted regression showed lower 60-day mortality for patients receiving antifungals (weighted HR, 0.28; 95% CI, 0.13-0.58; P < .001. INTERPRETATION: Our results show that antifungal treatment was associated with lower 60 day mortality in patients with CAPA. The high mortality rate observed in CAPA in immunocompromised patients and improved outcome for treated patients should encourage clinicians to actively screen for CAPA to enable rapid diagnosis and targeted treatment.
Related
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- Influenza A-associated pulmonary aspergillosis in critically ill patients in the post-COVID-19 era: a multicenter cohort study from China
- Clinical utility of CT-based deep learning for differentiating pulmonary aspergillosis from bacterial pneumonia: a multicenter retrospective study
- Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter, Retrospective Cohort Study in France (2022–2024)
- Dynamic Bronchoscopic Evolution of a Cobblestone-like Appearance in COVID-19-associated Pulmonary Aspergillosis: A Case Report
BibTeX
@article{reizine2026effects,
title = {{Effects of Antifungal Treatment in COVID-19-Associated Pulmonary Aspergillosis A European Multicenter Cohort Study}},
author = {Florian Reizine and Simon Feys and Danila Seidel and Matteo Mauget and Stefan Hatzl and Arnaud Gacouin and Yoann Launey and Jannes Heylen and Jean-Marc Tadie and Pierre Fillâtre and Matthias Verbesselt and Philipp Koehler and Marie-Elisabeth Bougnoux and Eric Dannaoui and Jean-Ralph Zahar and Hélène Guegan and Florence Robert-Gangneux and Mycovid Study Group and Joost Wauters and Oliver A. Cornely and Martin Hoenigl and Jean-Pierre Gangneux},
journal = {Chest},
year = {2026},
month = oct,
doi = {10.1016/j.chest.2026.04.001},
url = {https://hal.science/hal-05796528v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Effects of Antifungal Treatment in COVID-19-Associated Pulmonary Aspergillosis A European Multicenter Cohort Study
AU - Florian Reizine
AU - Simon Feys
AU - Danila Seidel
AU - Matteo Mauget
AU - Stefan Hatzl
AU - Arnaud Gacouin
AU - Yoann Launey
AU - Jannes Heylen
AU - Jean-Marc Tadie
AU - Pierre Fillâtre
AU - Matthias Verbesselt
AU - Philipp Koehler
AU - Marie-Elisabeth Bougnoux
AU - Eric Dannaoui
AU - Jean-Ralph Zahar
AU - Hélène Guegan
AU - Florence Robert-Gangneux
AU - Mycovid Study Group
AU - Joost Wauters
AU - Oliver A. Cornely
AU - Martin Hoenigl
AU - Jean-Pierre Gangneux
PY - 2026
DA - 2026/10/13
JO - Chest
DO - 10.1016/j.chest.2026.04.001
UR - https://hal.science/hal-05796528v1
AB - BACKGROUND: The management of COVID-19-associated invasive aspergillosis (CAPA) is still debated while cases continue to occur, and more and more frequently in vulnerable populations, stressing the importance of obtaining data on the treatment of this disease. Only small cohort studies and case reports have yet discussed this essential issue, and the data obtained are insufficient to make conclusions with confidence. RESEARCH QUESTION: Is antifungal treatment associated with lower 60-day mortality in patients with probable or proven CAPA? STUDY DESIGN AND METHODS: This study assessed the association of antifungal treatment with 60-day mortality for probable/proven CAPA cases from a French multicenter study and all consecutive CAPA cases (after 2020) from ICUs of 5 major European centers. Patients were compared according to antifungal treatment. Survival analysis was conducted by using Cox regression analysis and inverse probability of treatment weighting based on a propensity score. RESULTS: In total, 259 patients with CAPA were included, 237 (91.5%) receiving antifungals for CAPA (215 [90.7%] of whom received azole antifungal drugs). Baseline characteristics were similar between patients who received antifungals and those who did not. Age (hazard ratio [HR], 1.02; 95% CI, 1.00-1.04; P = .048), immunosuppressive treatment (HR, 2.08; 95% CI, 1.12-3.41; P < .001), and remdesivir administration (HR, 1.96; 95% CI, 1.12-3.41; P = .018) were independently associated with increased 60-day mortality according to Cox regression analysis in the raw population. Male sex (HR, 0.61; 95% CI, 0.40-0.95; P = .024) and antifungal treatment (HR, 0.31; 95% CI, 0.17-0.59; P < .001) were associated with lower 60-day mortality. Cox-weighted regression showed lower 60-day mortality for patients receiving antifungals (weighted HR, 0.28; 95% CI, 0.13-0.58; P < .001. INTERPRETATION: Our results show that antifungal treatment was associated with lower 60 day mortality in patients with CAPA. The high mortality rate observed in CAPA in immunocompromised patients and improved outcome for treated patients should encourage clinicians to actively screen for CAPA to enable rapid diagnosis and targeted treatment.
SN - 0012-3692
SN - 1931-3543
ER -