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

Year: 2026
Type: article
Study design: Observational Study
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.
DOI: 10.1016/j.ijid.2026.109089
Authors: Ming Xue, Zijing Zhou, Yali Chao, Jiaqiong Li, Jun Wang, Zhuxi Yu, Xiangrong Zuo, Shujun Zhou, Yanli Wang, Xuehua Pu, Chenliang Sun, Jiangquan Yu, Songqiao Liu, Jianfeng Xie, Ruiqiang Zheng, Yi Yang
Institutions: Fifth Affiliated Hospital of Xinjiang Medical University, Zhongda Hospital Southeast University, Southeast University, Zhejiang University, Affiliated Hospital of Xuzhou Medical College, Xuzhou Central Hospital, First Affiliated Hospital of Soochow University, Nanjing Drum Tower Hospital, Nanjing University, Jiangsu Province Hospital, Soochow University, The First People's Hospital of Changzhou, The First People’s Hospital of Lianyungang, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing Medical University, Affiliated Hospital of Nantong University, Northern Jiangsu People's Hospital, Xuzhou Medical College
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $2,900
Awards: G1632724801, G1877342767, G2431420134, G3122202340, G3664215222, G8111676723
OpenAlex ID: W7204645151
FWCI:
Cites: 28
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Related to: 10