Invasive pulmonary aspergillosis in critically ill patients with pneumonia due to COVID-۱۹, influenza, and communityacquired pneumonia: A prospective observational study

Background and Purpose: Influenza A and SARS-CoV-۲ are risk factors for invasive pulmonary aspergillosis. Both influenza-associated pulmonary aspergillosis and COVID-۱۹-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-۱۹-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-۱۹, 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-۱۹ pneumonia. The data collected included information on demographic characteristics, comorbidities, clinical features, laboratory results, treatment, and outcomes.Results: A total of ۱۴۰ patients were included in this study. These included ۳۵ (۲۵%), ۷۰ (۵۰%), and ۳۵ (۲۵%) patients with community-acquired pneumonia, influenza pneumonia, and COVID-۱۹ pneumonia, respectively. In addition, ۲۰ (۱۴.۲%) patients were found to have invasive aspergillosis, of whom ۱۰/۳۵ (۲۸.۵%), ۹/۷۰ (۱۲.۸%), and ۱/۳۵ (۲.۸%) patients were in the COVID-۱۹, influenza, and community-acquired pneumonia groups, respectively. Moreover, nine (۹۰%) COVID-۱۹-associated pulmonary aspergillosis patients required vasopressors, compared to three (۳۳%) patients with influenza-associated pulmonary aspergillosis (P=۰.۰۲۰). In total, seven (۷۰%) COVID-۱۹-associated pulmonary aspergillosis patients required invasive mechanical ventilation compared to four (۴۴%) influenza-associated pulmonary aspergillosis patients (P=۰.۳۷). The mean±SD length of hospital stay was highest in the COVID-۱۹-associated pulmonary aspergillosis patients (۱۸.۳±۷.۲۸ days) compared to influenza-associated pulmonary aspergillosis patients (۱۱.۷±۵.۳۴ days) (P=۰.۰۳۶). The number of deaths in influenza-associated pulmonary aspergillosis and COVID-۱۹-associated pulmonary aspergillosis patients was three (۳۳.۳%) and five (۵۰%), respectively (P=۰.۵۲۶).Conclusion: A higher proportion of patients with COVID-۱۹ developed invasive aspergillosis compared to those with influenza. Although the mortality rate in COVID-۱۹-associated pulmonary aspergillosis was comparable to that in influenza-associated pulmonary aspergillosis patients, COVID-۱۹-associated pulmonary aspergillosis patients had a significantly longer stay in the hospital.