invasive pulmonary aspergillosis in critically ill patients with pneumonia due to covid-19, influenza, and communityacquired pneumonia: a prospective observational study

Background and purpose: influenza a and sars-cov-2 are risk factors for invasive pulmonary aspergillosis. both influenza-associated pulmonary aspergillosis and covid-19-associated pulmonary aspergillosis result in high mortality and poor clinical outcomes. no prospective study has so far compared the features, treatment, and outcomes of influenza-associated pulmonary aspergillosis and covid-19-associated pulmonary aspergillosis within a similar time frame. therefore, this study aimed to determine the frequency, risk factors, and outcomes of invasive pulmonary aspergillosis in critically ill patients with influenza, covid-19, and community-acquired pneumonia. materials and methods: this prospective study included adult patients with pneumonia and was conducted at the aga khan university hospital in karachi, pakistan. patients were divided into three groups, including community-acquired pneumonia, influenza pneumonia, and covid-19 pneumonia. the data collected included information on demographic characteristics, comorbidities, clinical features, laboratory results, treatment, and outcomes. results: a total of 140 patients were included in this study. these included 35 (25%), 70 (50%), and 35 (25%) patients with community-acquired pneumonia, influenza pneumonia, and covid-19 pneumonia, respectively. in addition, 20 (14.2%) patients were found to have invasive aspergillosis, of whom 10/35 (28.5%), 9/70 (12.8%), and 1/35 (2.8%) patients were in the covid-19, influenza, and community-acquired pneumonia groups, respectively. moreover, nine (90%) covid-19-associated pulmonary aspergillosis patients required vasopressors, compared to three (33%) patients with influenza-associated pulmonary aspergillosis (p=0.020). in total, seven (70%) covid-19-associated pulmonary aspergillosis patients required invasive mechanical ventilation compared to four (44%) influenza-associated pulmonary aspergillosis patients (p=0.37). the mean±sd length of hospital stay was highest in the covid-19-associated pulmonary aspergillosis patients (18.3±7.28 days) compared to influenza-associated pulmonary aspergillosis patients (11.7±5.34 days) (p=0.036). the number of deaths in influenza-associated pulmonary aspergillosis and covid-19-associated pulmonary aspergillosis patients was three (33.3%) and five (50%), respectively (p=0.526). conclusion: a higher proportion of patients with covid-19 developed invasive aspergillosis compared to those with influenza. although the mortality rate in covid-19-associated pulmonary aspergillosis was comparable to that in influenza-associated pulmonary aspergillosis patients, covid-19-associated pulmonary aspergillosis patients had a significantly longer stay in the hospital.