Influenza A-Associated Pulmonary Aspergillosis in Critically Ill Patients in the Post-COVID-19 Era: A Multicenter Cohort Study from China
In brief
One third of severe influenza ICU patients get invasive aspergillosis; half die
In a 21-ICU Chinese cohort of 542 adults with severe influenza A pneumonia, 33% were diagnosed with invasive pulmonary aspergillosis within a median of two days. Those with aspergillosis faced a 60-day mortality of 48% versus 32% in those without, especially if they had hematologic disease or high CRP. Early screening and rapid diagnostics are urgently needed.
- Journal
- International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Q1)
- Published
- 29 August 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Ming Xue, Zijing Zhou, Yali Chao, Jiaqiong Li, Jun Wang, Zhuxi Yu, et al.
- PMID
- 42668058
- DOI
- 10.1016/j.ijid.2026.109089
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 3 September 2026): Influenza‑associated aspergillosis in ICU
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.