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SHR Neuro Cancer Cardio Lipid Metab Microb
Prattes, J; Giacobbe, DR; Marelli, C; Signori, A; Dettori, S; Cattardico, G; Hatzl, S; Reisinger, AC; Eller, P; Krause, R; Reizine, F; Bassetti, M; Gangneux, JP; Hoenigl, M.
Posaconazole for Prevention of COVID-19-Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients: A European Multicentre Case-Control Study (POSACOVID).
Mycoses. 2025; 68(1): e70023
Doi: 10.1111/myc.70023
[OPEN ACCESS]
Web of Science
PubMed
FullText
FullText_MUG
- Leading authors Med Uni Graz
- Prattes Jürgen
- Co-authors Med Uni Graz
- Eller Philipp
- Hatzl Stefan
- Hönigl Martin
- Krause Robert
- Reisinger Alexander Christian
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- Abstract:
- BACKGROUND: This study investigated the impact of posaconazole (POSA) prophylaxis in COVID-19 patients with acute respiratory failure receiving systemic corticosteroids on the risk for the development of COVID-19-associated pulmonary aspergillosis (CAPA). METHODS: The primary aim of this prospective, multicentre, case-control study was to assess whether application of POSA prophylaxis in mechanically ventilated COVID-19 patients reduces the risk for CAPA development. All consecutive patients from centre 1 (cases) who received POSA prophylaxis as standard-of-care were matched to one subject from centre 2 and centre 3 who did not receive any antifungal prophylaxis, using propensity score matching for the following variables: (i) age, (ii) sex, (iii) treatment with tocilizumab and (iv) time at risk. RESULTS: Eighty-three consecutive patients receiving POSA prophylaxis were identified at centre 1 and matched to 166 controls. In the matched cohort, incidence rates of CAPA were 1.69 (centre 1), 0.84 (centre 2) and 7.18 (centre 3) events per 1000 ICU days. In multivariable logistic regression analysis, the presence of an EORTC/MSGERC risk factor at ICU admission (OR 4.35) and centre 3 versus centre 1 (OR 6.07; 95% CI 1.76-20.91; p = 0.004) were associated with an increased risk of CAPA. No increased risk of CAPA was registered for centre 2 versus centre 1. CONCLUSIONS: The impact of POSA prophylaxis depends on the baseline CAPA incidence rate, which varies widely between centres. Future trials should therefore investigate targeted antifungal prophylaxis (e.g., stratified for high-prevalence centres or high-risk patients) in COVID-19 patients. TRIAL REGISTRATION: NCT05065658.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Male - administration & dosage
- Female - administration & dosage
- Case-Control Studies - administration & dosage
- Antifungal Agents - therapeutic use, administration & dosage
- Middle Aged - administration & dosage
- Aged - administration & dosage
- COVID-19 - complications
- Prospective Studies - administration & dosage
- Respiration, Artificial - adverse effects
- SARS-CoV-2 - administration & dosage
- Pulmonary Aspergillosis - complications, drug therapy
- Europe - administration & dosage
- Triazoles - therapeutic use
- COVID-19 Drug Treatment - administration & dosage
- Find related publications in this database (Keywords)
- COVID-19-associated pulmonary aspergillosis
- ICU
- Posaconazole
- prophylaxis