High mortality and mechanical ventilation in COVID-19-associated pulmonary aspergillosis: Insights from a two-center retrospective cohort

Aifang Zhong¹Weijun Jiang²Yang Yang²Jun Hong²Qiuyue Wu²Lei Xiong²Li Han²Changjun Wang²Jiang Wu²Xinyi Xia^2*

• ¹Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
• ²Institute of Laboratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

Abstract Background: Studies of COVID-19 associated pulmonary aspergillosis (CAPA) have raised concerns about its high mortality. This study aims to assess the mortality of CAPA caused by the alpha and omicron variants among ICU patients during two distinct waves in China. Methods: We enrolled 236 ICU patients admitted to Wuhan Huoshenshan Hospital from January 4, 2020, to March 30, 2022, during the alpha variant epidemic, and 187 ICU patients admitted to Nanjing Jinling Hospital from October 24, 2022, to January 19, 2023, during the omicron variant epidemic. We systematically collected clinical data for analysis, and all patients were confirmed to have SARS-CoV-2 infection via PCR. Results: The incidence rate of CAPA was 5.1% (12/236) during the alpha variant period and 7.5% (14/187) during the omicron variant period. The mortality rate among CAPA cases was 33.3% (4/12) for patients infected with the alpha variant and 28.6% (4/14) for patients infected with the omicron variant, both higher than the mortality rate among non-CAPA patients: 4.9% (11/224) during the alpha period and 8.7% (15/173) during the omicron period. Mechanical ventilation requires careful consideration for CAPA patients. Aspergillus fumigatus was the most frequently identified causative agent in CAPA cases, with Aspergillus flavus found in only one case. Conclusions: Our findings emphasize the necessity for implementing more