Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter, Retrospective Cohort Study in France (2022–2024)
Abstract
Background: Suspected invasive pulmonary aspergillosis (IPA) is increasingly treated in intensive care, including in patients without classical immunosuppression. Whether current research definitions (European Organization for Research and Treatment of Cancer [EORTC]/Mycoses Study Group Education and Research Consortium (MSGERC), Invasive Fungal Diseases in Adult Patients in ICU [FUNDICU]) classify treated cases and predict mortality is unclear. Methods: We retrospectively included adults in 48 French intensive care units who received systemic antifungal therapy for suspected IPA (January 2022 to July 2024). Patients were categorized as having modified EORTC/MSGERC probable IPA, FUNDICU probable IPA, or unclassified. Ninety-day mortality was analyzed using multivariable Cox regression; heterogeneity was explored with unsupervised clustering. Results: = .24). In adjusted analyses, IPA categorization was not associated with mortality (FUNDICU vs EORTC: adjusted hazard ratio [aHR] = 0.86, 95% CI .62-1.20; unclassified vs EORTC: aHR = 0.89, .62-1.30). Age (aHR 1.03/year, 1.02-1.05), Sequential Organ Failure Assessment (1.06/point, 1.03-1.10), and frailty (1.17/point, 1.07-1.30) independently predicted 90-day mortality. Exploratory clustering identified 6 phenotypes with 90-day mortality ranging from 40% to 80%. Conclusions: Nearly 1 in 5 intensive care patients treated for suspected IPA were not classifiable by EORTC/MSGERC or FUNDICU definitions. Mortality was more strongly associated with age, frailty, and acute severity than with classification category, supporting ICU-focused diagnostic frameworks and risk stratification; these associations should be read in light of the treatment-based design and do not establish that the definitions lack diagnostic value.
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BibTeX
@article{villa2026unclassifiable,
title = {{Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter, Retrospective Cohort Study in France (2022–2024)}},
author = {Antoine Villa and Benoit Painvin and Antoine Hérault and Pierre-Marie Bourgeois and Bastien Peiffer and Sibylle Cunat and Fanny Vincent and Luc Juban and Luc Desmedt and Marine de Bony de Lavergne and Marin Caumartin and Rania Bounab and Loïc Prez and Julien Dessajan and François Dhelft and Jérémie Mallet and Marc Pineton de Chambrun and Grégoire Fourcade and Cédric Darreau and Donatien de Marignan and Guillaume Louis and Florent Wallet and Maxime Desgrouas and Kévin Vanneck Kamdem and Hamza Chraibi and Florian Reizine and Tomas Urbina and Françoise Botterel and Fanny Lanternier and Laurence Millon and Saad Nseir and Nicolas de Prost and Jonathan Chelly and Marc Gainnier and Octave Cannac and Martin Cour and Emmanuelle Guérin and Sébastien Jochmans and Loïc Le Guennec and Damien Contou and Adrien Pons and Jean-Pierre Quenot and Fabrice Uhel and Asaël Berger and Maxens Decavele and Antoine Guillon and Pascal Beuret and Cindy Lage and Djamel Mokart and Octave Cannac and Victor Penaud and Antoine Lafarge and Julien Maizel and Rémy Nyga and Jean-Philippe Rigaud and Matthieu Turpin and Sophie Nagle and Pierre Bay and Keyvan Razazi},
journal = {Open Forum Infectious Diseases},
year = {2026},
month = sep,
doi = {10.1093/ofid/ofag519},
url = {https://hal.science/hal-05799891v1},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter, Retrospective Cohort Study in France (2022–2024)
AU - Antoine Villa
AU - Benoit Painvin
AU - Antoine Hérault
AU - Pierre-Marie Bourgeois
AU - Bastien Peiffer
AU - Sibylle Cunat
AU - Fanny Vincent
AU - Luc Juban
AU - Luc Desmedt
AU - Marine de Bony de Lavergne
AU - Marin Caumartin
AU - Rania Bounab
AU - Loïc Prez
AU - Julien Dessajan
AU - François Dhelft
AU - Jérémie Mallet
AU - Marc Pineton de Chambrun
AU - Grégoire Fourcade
AU - Cédric Darreau
AU - Donatien de Marignan
AU - Guillaume Louis
AU - Florent Wallet
AU - Maxime Desgrouas
AU - Kévin Vanneck Kamdem
AU - Hamza Chraibi
AU - Florian Reizine
AU - Tomas Urbina
AU - Françoise Botterel
AU - Fanny Lanternier
AU - Laurence Millon
AU - Saad Nseir
AU - Nicolas de Prost
AU - Jonathan Chelly
AU - Marc Gainnier
AU - Octave Cannac
AU - Martin Cour
AU - Emmanuelle Guérin
AU - Sébastien Jochmans
AU - Loïc Le Guennec
AU - Damien Contou
AU - Adrien Pons
AU - Jean-Pierre Quenot
AU - Fabrice Uhel
AU - Asaël Berger
AU - Maxens Decavele
AU - Antoine Guillon
AU - Pascal Beuret
AU - Cindy Lage
AU - Djamel Mokart
AU - Octave Cannac
AU - Victor Penaud
AU - Antoine Lafarge
AU - Julien Maizel
AU - Rémy Nyga
AU - Jean-Philippe Rigaud
AU - Matthieu Turpin
AU - Sophie Nagle
AU - Pierre Bay
AU - Keyvan Razazi
PY - 2026
DA - 2026/09/01
JO - Open Forum Infectious Diseases
DO - 10.1093/ofid/ofag519
UR - https://hal.science/hal-05799891v1
AB - Background: Suspected invasive pulmonary aspergillosis (IPA) is increasingly treated in intensive care, including in patients without classical immunosuppression. Whether current research definitions (European Organization for Research and Treatment of Cancer [EORTC]/Mycoses Study Group Education and Research Consortium (MSGERC), Invasive Fungal Diseases in Adult Patients in ICU [FUNDICU]) classify treated cases and predict mortality is unclear. Methods: We retrospectively included adults in 48 French intensive care units who received systemic antifungal therapy for suspected IPA (January 2022 to July 2024). Patients were categorized as having modified EORTC/MSGERC probable IPA, FUNDICU probable IPA, or unclassified. Ninety-day mortality was analyzed using multivariable Cox regression; heterogeneity was explored with unsupervised clustering. Results: = .24). In adjusted analyses, IPA categorization was not associated with mortality (FUNDICU vs EORTC: adjusted hazard ratio [aHR] = 0.86, 95% CI .62-1.20; unclassified vs EORTC: aHR = 0.89, .62-1.30). Age (aHR 1.03/year, 1.02-1.05), Sequential Organ Failure Assessment (1.06/point, 1.03-1.10), and frailty (1.17/point, 1.07-1.30) independently predicted 90-day mortality. Exploratory clustering identified 6 phenotypes with 90-day mortality ranging from 40% to 80%. Conclusions: Nearly 1 in 5 intensive care patients treated for suspected IPA were not classifiable by EORTC/MSGERC or FUNDICU definitions. Mortality was more strongly associated with age, frailty, and acute severity than with classification category, supporting ICU-focused diagnostic frameworks and risk stratification; these associations should be read in light of the treatment-based design and do not establish that the definitions lack diagnostic value.
SN - 2328-8957
SN - 2328-8957
ER -