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Peer-reviewedCC BYInternational Journal of Infectious Diseases

Influenza A-associated pulmonary aspergillosis in critically ill patients in the post-COVID-19 era: a multicenter cohort study from China

  • Ming Xue1
  • Zijing Zhou2
  • Yali Chao3
  • Jiaqiong Li4
  • Jun Wang5
  • Zhuxi Yu6
  • Xiangrong Zuo7
  • Shujun Zhou8
  • Yanli Wang9
  • Xuehua Pu10
  • Chenliang Sun11
  • Jiangquan Yu12
4 more authors
  • Songqiao Liu
  • Jianfeng Xie13
  • Ruiqiang Zheng
  • Yi Yang
13 affiliations
  1. 1China National Critical Care Quality Control Center, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China; Department of Critical Care Medicine, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
  2. 2China National Critical Care Quality Control Center, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China; The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
  3. 3Department of Critical Care Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China; China National Critical Care Quality Control Center, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
  4. 4Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
  5. 5Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  6. 6Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
  7. 7Department of Intensive Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
  8. 8Department of Critical Care Medicine, The First People’s Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
  9. 9Department of Emergency and Critical Care Medicine, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
  10. 10Department of Critical Care Medicine, The Affiliated Taizhou People’s Hospital of Nanjing Medical University, Taizhou, Jiangsu, China
  11. 11Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
  12. 12Department of Critical Care Medicine, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
  13. 13China National Critical Care Quality Control Center, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China
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Abstract

Background: To determine the incidence, risk factors, and outcomes of invasive pulmonary aspergillosis (IPA) in critically ill patients with Influenza A pneumonia in post-COVID-19 China. Methods: We conducted a multicenter retrospective cohort study across 21 ICUs (November 2024-February 2025) including adults with acute respiratory failure due to confirmed severe Influenza A pneumonia. IPA was defined by 2024 FUNDICU criteria. The primary outcome was 60-day all-cause mortality. Results: Among 542 patients, 179 (33.0%) had IPA. Independent risk factors: renal replacement therapy (aOR 1.63), diabetes (aOR 1.79), bacterial co-infection (aOR 1.64), pre-ICU systemic glucocorticoids (aOR 2.13), and ICU steroids (aOR 1.53). Median time from influenza to IPA diagnosis was 2 days. Sixty-day mortality was higher with IPA (47.5% vs 32.0%, P < 0.001), persisting after matching. Among IPA patients, hematologic disorders (aHR 5.31) and higher CRP predicted death. Conclusions: In the post-COVID-19 era, IPA is highly prevalent and lethal in severe influenza, with rapid onset. Protocolized screening and timely diagnostic strategies are urgently needed.

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Cite

BibTeXRIS
BibTeX
@article{xue2026influenza,
  title = {{Influenza A-associated pulmonary aspergillosis in critically ill patients in the post-COVID-19 era: a multicenter cohort study from China}},
  author = {Ming Xue and Zijing Zhou and Yali Chao and Jiaqiong Li and Jun Wang and Zhuxi Yu and Xiangrong Zuo and Shujun Zhou and Yanli Wang and Xuehua Pu and Chenliang Sun and Jiangquan Yu and Songqiao Liu and Jianfeng Xie and Ruiqiang Zheng and Yi Yang},
  journal = {International Journal of Infectious Diseases},
  year = {2026},
  month = oct,
  doi = {10.1016/j.ijid.2026.109089},
  url = {https://doi.org/10.1016/j.ijid.2026.109089},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Influenza A-associated pulmonary aspergillosis in critically ill patients in the post-COVID-19 era: a multicenter cohort study from China
AU  - Ming Xue
AU  - Zijing Zhou
AU  - Yali Chao
AU  - Jiaqiong Li
AU  - Jun Wang
AU  - Zhuxi Yu
AU  - Xiangrong Zuo
AU  - Shujun Zhou
AU  - Yanli Wang
AU  - Xuehua Pu
AU  - Chenliang Sun
AU  - Jiangquan Yu
AU  - Songqiao Liu
AU  - Jianfeng Xie
AU  - Ruiqiang Zheng
AU  - Yi Yang
PY  - 2026
DA  - 2026/10/30
JO  - International Journal of Infectious Diseases
DO  - 10.1016/j.ijid.2026.109089
UR  - https://doi.org/10.1016/j.ijid.2026.109089
AB  - Background: To determine the incidence, risk factors, and outcomes of invasive pulmonary aspergillosis (IPA) in critically ill patients with Influenza A pneumonia in post-COVID-19 China. Methods: We conducted a multicenter retrospective cohort study across 21 ICUs (November 2024-February 2025) including adults with acute respiratory failure due to confirmed severe Influenza A pneumonia. IPA was defined by 2024 FUNDICU criteria. The primary outcome was 60-day all-cause mortality. Results: Among 542 patients, 179 (33.0%) had IPA. Independent risk factors: renal replacement therapy (aOR 1.63), diabetes (aOR 1.79), bacterial co-infection (aOR 1.64), pre-ICU systemic glucocorticoids (aOR 2.13), and ICU steroids (aOR 1.53). Median time from influenza to IPA diagnosis was 2 days. Sixty-day mortality was higher with IPA (47.5% vs 32.0%, P < 0.001), persisting after matching. Among IPA patients, hematologic disorders (aHR 5.31) and higher CRP predicted death. Conclusions: In the post-COVID-19 era, IPA is highly prevalent and lethal in severe influenza, with rapid onset. Protocolized screening and timely diagnostic strategies are urgently needed.
SN  - 1201-9712
SN  - 1878-3511
ER  -