Occurrence of Invasive Pulmonary Fungal Infections in Severe COVID-19 Patients Admitted to the ICU

Arnaud Fekkar, Alexandre Lampros, Julien Mayaux, Corentin Poignon, Sophie Demeret, Jean-Michel Constantin, Anne-Geneviève Marcelin, Antoine Monsel, Charles-Edouard Luyt, Marion Blaize
American Journal of Respiratory and Critical Care Medicine 2020 December 2

RATIONALE: Whether severe COVID-19 is a significant risk factor for the development of invasive fungal superinfections is of great medical interest and remains for now an open question.

OBJECTIVES: We aim to assess the occurrence of invasive fungal respiratory superinfections in patients with severe COVID-19.

METHODS: We conducted the study on patients with severe SARS-CoV2 related pneumonia admitted to 5 intensive care units in France, who had respiratory and serum sampling performed for specific screening of fungal complication.

MEASUREMENTS AND MAIN RESULTS: The study population included a total of 145 patients the median age was 55 years old, most of them were male (n=104; 72%), were overweight (n=99; 68%), suffered from hypertension (n=83; 57%) and diabetes (n=46; 32%). Few patients presented preexisting host risk factors for invasive fungal infection (n=20; 14%). Their global severity was high: all patients were on invasive mechanical ventilation and half (n= 73, 54%) were on extracorporeal membrane oxygenation support. Mycological analysis included 2815 mycological tests (culture, galactomannan, beta-glucan, PCR) performed on 475 respiratory samples and 532 sera. A probable/putative invasive pulmonary mold infection was diagnosed in 7 (4.8%) patients and linked to high mortality. Multivariate analysis indicates a significantly higher risk for solid organ transplant recipients (OR=4.66 [1.98; 7.34], p=0.004). False positive fungal test and clinically irrelevant colonization, which did not require initiation of antifungal treatment, was observed in 25 patients (17.2%).

CONCLUSIONS: In patients with no underlying immunosuppression, severe SARS-CoV-2 related pneumonia seems at low risk of invasive fungal secondary infection, especially aspergillosis. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (

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