Unclassifiable Invasive Pulmonary Aspergillosis in the Intensive Care Unit: Insights From a Multicenter, Retrospective Cohort Study in France (2022–2024)
Year: 2026
Type: article
Study design: Observational Study
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.
Source: Open Forum Infectious Diseases
DOI: 10.1093/ofid/ofag519
Authors: Antoine Villa, Benoit Painvin, Antoine Hérault, Pierre-Marie Bourgeois, Bastien Peiffer, Sibylle Cunat, Fanny Vincent, Luc Juban, Luc Desmedt, Marine de Bony de Lavergne, Marin Caumartin, Rania Bounab, Loïc Prez, Julien Dessajan, François Dhelft, Jérémie Mallet, Marc Pineton de Chambrun, Grégoire Fourcade, Cédric Darreau, Donatien de Marignan, Guillaume Louis, Florent Wallet, Maxime Desgrouas, Kévin Vanneck Kamdem, Hamza Chraibi, Florian Reizine, Tomas Urbina, Françoise Botterel, Fanny Lanternier, Laurence Millon, Saad Nseir, Nicolas de Prost, the ASPIRE Study Group Collaborators, Jonathan Chelly, Marc Gainnier, Octave Cannac, Martin Cour, Emmanuelle Guérin, Sébastien Jochmans, Loïc Le Guennec, Damien Contou, Adrien Pons, Jean-Pierre Quenot, Fabrice Uhel, Asaël Berger, Maxens Decavele, Antoine Guillon, Pascal Beuret, Cindy Lage, Djamel Mokart, Octave Cannac, Victor Penaud, Antoine Lafarge, Julien Maizel, Rémy Nyga, Jean-Philippe Rigaud, Matthieu Turpin, Sophie Nagle, Pierre Bay, Keyvan Razazi
Institutions: Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Centre Hospitalier Universitaire de Rennes, Inserm, Endothélium, valvulopathies et insuffisance cardiaque, Centre Hospitalier Universitaire de Rouen, Université de Rouen Normandie, Centre Hospitalier Universitaire de Montpellier, Hôpitaux Universitaires de Strasbourg, Hôpital Civil, Strasbourg, Centre Hospitalier Annecy Genevois, Assistance Publique Hôpitaux de Marseille, Hôpital Nord, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire de Bordeaux, Hôpital Cochin, Hôpital Raymond-Poincaré, Centre Hospitalier Universitaire de Lille, Hôpital Bichat-Claude-Bernard, Bicêtre Hospital, Pitié-Salpêtrière Hospital, Centre Hospitalier Universitaire de Grenoble, Centre Hospitalier du Mans, Hospices Civils de Lyon, Hôpital Lyon Sud, Centre Hospitalier Régional de Metz-Thionville, Hôpital de la Croix-Rousse, Centre hospitalier universitaire d'Orléans, Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Centre Hospitalier Régional Universitaire de Brest, Centre hospitalier Bretagne Atlantique, Sorbonne Université, Hôpital Saint-Antoine, Université Paris-Est Créteil, Institut Mondor de Recherche Biomédicale, DYNAMYC MYCOLOGY, Hôpital Necker-Enfants Malades, Institut Pasteur, Université Paris Cité, Centre National de la Recherche Scientifique, Centre Hospitalier Universitaire de Besançon, Laboratoire Chrono-Environnement, Université Marie et Louis Pasteur, Université de Lille, Unité de Glycobiologie Structurale et Fonctionnelle
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
Funder: Hospices Civils de Lyon
OpenAlex ID: W7203769604