• Rebecca van Grootveld, Martha T van der Beek, Nico A F Janssen, Mehmet Ergün, Karin van Dijk, Carina Bethlehem, Susanne Stads, Judith van Paassen, HeunksLeo M ALMAAmsterdam University Medical Center, Amsterdam, the Netherlands; Erasmus University Medical Center, Rotterdam, the Netherlands., BoumanCatherine S CCSCAmsterdam University Medical Center, Amsterdam, the Netherlands., Monique H E Reijers, Roger J Brüggeman, Frank L van de Veerdonk, van BreeSjoerd H WSHWGelderse Vallei Hospital, Ede, the Netherlands., Charlotte H S B van den Berg, Marnix Kuindersma, Joost Wauters, Albertus Beishuizen, Paul E Verweij, Jeroen A Schouten, and CAPA2.0 study group.
• Leiden University Medical Center, Leiden, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Electronic address: r.van_grootveld@lumc.nl.
• J Crit Care. 2023 Aug 1; 76: 154272154272.

PurposeCOVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment.Materials And MethodsA retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria.ResultsCAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy.ConclusionsCAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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