Aldejohann, Leonie H. and Steinmann, Joerg and Rügamer, Tamara and Martin, Ronny and Thielemann, Nadja and Walther, Grit and Kurzai, Oliver and Aldejohann, Alexander M. (2025) Culture-positive COVID-19-associated pulmonary aspergillosis (CAPA) in Germany. INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY, 321: 151676. ISSN 1438-4221, 1618-0607
Full text not available from this repository. (Request a copy)Abstract
Background COVID-19-associated-pulmonary-aspergillosis (CAPA) is a severe superinfection mostly affecting critically ill COVID-19 patients. Early diagnosis and clinical management of CAPA remain major clinical challenges. Here, we evaluated different approaches to classify culture-positive CAPA at its peak season, assessed incidence and mortality, identified risk factors and analysed clinical and laboratory CAPA-management of three German tertiary care hospitals. Methods A retrospective multi-center analysis was performed. Inclusion criteria were SARS-CoV-2-positivity, Aspergillus-culture-positivity of lower respiratory tract specimen and ARDS. Cases were primarily classified according to ECMM/ISHAM-criteria. Species-ID was confirmed by each center. Susceptibility was assessed by EUCAST-microdilution or VIPcheck-screening. Statistical analysis revealed mortality affecting factors. Results 95 culture-positive CAPA cases were classified as possible (36/95) or probable (59/95) by ECMM/ISHAM; 54 probable cases matched 2 or 3 additional classifications. Incidence rates were higher in ICU (2020/21: 1.56 %/2.13 % non-ICU vs. 5.14 %/6.77 % ICU). A. fumigatus was the most abundant species (93 %; (88/95)). Most patients received steroids to treat COVID-19-ARDS and required respiratory support (steroids: 71 % (67/95); intubated patients 52 % (49/95); ECMO (48 % (46/95)). Retrospective evaluation showed adherence to ECMM/ISHAM antifungal therapy guideline in 71 % (67/95). Case fatality rate was 60 % (57/95). A significant association between GM indices > 3 in respiratory fluid or nicotine abuse (p = 0.035 FE, OR=0.252, 95 % CI=0.066-0.986) and mortality was observed in univariate analysis. Convalescent plasma therapy was significantly associated with mortality reduction in uni- and multivariate analysis (p = 0.020). Conclusion Our data reveal regional differences in prevalence, diagnosis, and treatment of culture-positive CAPA in Germany. We could identify new factors affecting survival or mortality.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | BRONCHOALVEOLAR LAVAGE FLUID; INTENSIVE-CARE-UNIT; COVID-19; GALACTOMANNAN; DISEASE; RISK; CAPA; Culture-positive CAPA; A. fumigatus; Aspergillus; COVID-19 |
| Subjects: | 500 Science > 570 Life sciences 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Medizinische Mikrobiologie und Hygiene |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 26 May 2026 12:11 |
| Last Modified: | 26 May 2026 12:11 |
| URI: | https://pred.uni-regensburg.de/id/eprint/67414 |
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