Background Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) emerged as important fungal complications in patients with COVID-19-associated severe acute respiratory failure (ARF). Whether mould active antifungal prophylaxis (MAFP) can prevent CAPA remains elusive so far. Methods In this observational study, we included all consecutive patients admitted to intensive care units with COVID-19-associated ARF between September 1, 2020, and May 1, 2021. We compared patients with versus without antifungal prophylaxis with respect to CAPA incidence (primary outcome) and mortality (secondary outcome). Propensity score adjustment was performed to account for any imbalances in baseline characteristics. CAPA cases were classified according to European Confederation of Medical Mycology (ECMM)/International Society of Human and Animal Mycoses (ISHAM) consensus criteria. Results We included 132 patients, of whom 75 (57%) received antifungal prophylaxis (98% posaconazole). Ten CAPA cases were diagnosed, after a median of 6 days following ICU admission. Of those, 9 CAPA cases were recorded in the non-prophylaxis group and one in the prophylaxis group, respectively. However, no difference in 30-day ICU mortality could be observed. Thirty-day CAPA incidence estimates were 1.4% (95% CI 0.2–9.7) in the MAFP group and 17.5% (95% CI 9.6–31.4) in the group without MAFP ( p = 0.002). The respective subdistributional hazard ratio (sHR) for CAPA incidence comparing the MAFP versus no MAFP group was of 0.08 (95% CI 0.01–0.63; p = 0.017). Conclusion In ICU patients with COVID-19 ARF, antifungal prophylaxis was associated with significantly reduced CAPA incidence, but this did not translate into improved survival. Randomized controlled trials are warranted to evaluate the efficacy and safety of MAFP with respect to CAPA incidence and clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03753-9.
【저자키워드】 ICU, CAPA, COVID-19-associated aspergillosis, Posaconazole, Mould prophylaxis, 【초록키워드】 Respiratory failure, Mortality, Human, intensive care unit, clinical outcomes, Prophylaxis, survival, animal, Patient, ICU admission, Controlled trial, Complication, Efficacy and safety, incidence, coronavirus disease 19, estimate, patients, fungal, Propensity score, criteria, mycology, Society, Consensus, Primary outcome, supplementary material, 95% CI, baseline characteristics, hazard ratio, no difference, secondary outcome, European, Prevent, ICU patient, Result, evaluate, significantly, diagnosed, was performed, reduced, median, ARF, translate, were recorded, consecutive patient, mould, Mycose, with COVID-19, 【제목키워드】 Prophylaxis, Critically ill, Antifungal,