Pulmonary Aspergillosis Linked to Influenza A in Critically Ill Patients During the Post-COVID-19 Period: A Multicenter Cohort Analysis from China

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Influenza-associated pulmonary aspergillosis (IAPA) was diagnosed in 179 of 542 critically ill adults with influenza A pneumonia (33.0%) in this multicenter Chinese cohort.
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Sixty-day mortality was 47.5% among patients with IAPA versus 32.0% among those without it. The difference remained significant after propensity score matching but does not establish causation.
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The median interval from influenza diagnosis to aspergillosis diagnosis was 2 days. Diabetes, renal replacement therapy, bacterial coinfection, and corticosteroid use were independently associated with aspergillosis.
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The retrospective study included patients admitted to 21 ICUs in Jiangsu Province from November 2024 through February 2025. Clinician-directed testing means the reported frequency reflects clinically detected disease rather than true prevalence.
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Diagnosis used the 2024 FUNDICU criteria, combining clinical, radiological, and mycological findings without requiring classic immunocompromising host factors. Some patients meeting these criteria may have had colonization rather than invasive infection.

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