Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study
Abstract Background: COVID-associated pulmonary aspergillosis (CAPA) was described early in the pandemic as a complication of SARS-CoV-2. Data about incidence of aspergillosis and characteristics of affected patients after mid-2021 are limited. Methods: A retrospective, nationwide cohort of US V...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2025-01-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X24004765/type/journal_article |
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| author | Kaitlin Swinnerton Nathanael R. Fillmore Ikwo Oboho Janet Grubber Mary Brophy Nhan V Do Paul A Monach Westyn Branch-Elliman |
| author_facet | Kaitlin Swinnerton Nathanael R. Fillmore Ikwo Oboho Janet Grubber Mary Brophy Nhan V Do Paul A Monach Westyn Branch-Elliman |
| author_sort | Kaitlin Swinnerton |
| collection | DOAJ |
| description |
Abstract
Background:
COVID-associated pulmonary aspergillosis (CAPA) was described early in the pandemic as a complication of SARS-CoV-2. Data about incidence of aspergillosis and characteristics of affected patients after mid-2021 are limited.
Methods:
A retrospective, nationwide cohort of US Veterans with SARS-CoV-2 from 1/1/2020 to 2/7/2024 was created. Potential cases of aspergillosis ≤12 weeks of a SARS-CoV-2 test were flagged electronically (based on testing results indicative of invasive fungal infection, antifungal therapy, and/or ICD-10 codes), followed by manual review to establish the clinical diagnosis of pulmonary aspergillosis. Incidence rates were calculated per 10,000 SARS-CoV-2 cases. Selected clinical characteristics included age >70, receipt of immune-compromising drugs, hematologic malignancy, chronic respiratory disease, vaccination status, and vaccine era. Multivariate logistic regression was used to estimate the independent effects of these variables via adjusted odds ratios (aOR).
Results:
Among 674,343 Veterans with SARS-CoV-2, 165 were electronically flagged for review. Of these, 66 were judged to be cases of aspergillosis. Incidence proportions ranged from 0.30/10,000 among patients with zero risk factors to 34/10,000 among those with ≥3 risk factors; rates were similar in the pre- and post-vaccination eras. The 90-day mortality among aspergillosis cases was 50%. In the multivariate analysis, immune suppression (aOR 6.47, CI 3.84–10.92), chronic respiratory disease (aOR 3.57, CI 2.10–6.14), and age >70 (aOR 2.78, CI 1.64–4.80) were associated with aspergillosis.
Conclusions:
Patients with underlying risk factors for invasive aspergillosis continue to be at some risk despite SARS-CoV-2 immunization. Risk in patients without immune suppression or preexisting lung disease is very low.
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| format | Article |
| id | doaj-art-365380632a11481789fd58f2174f47de |
| institution | Kabale University |
| issn | 2732-494X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj-art-365380632a11481789fd58f2174f47de2025-01-30T09:43:13ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2025-01-01510.1017/ash.2024.476Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort studyKaitlin Swinnerton0https://orcid.org/0000-0002-7429-9960Nathanael R. Fillmore1Ikwo Oboho2https://orcid.org/0000-0002-0654-0900Janet Grubber3Mary Brophy4Nhan V Do5https://orcid.org/0000-0001-6868-7011Paul A Monach6Westyn Branch-Elliman7https://orcid.org/0000-0002-9658-5124VA Boston Cooperative Studies Program, Boston, MA, USAVA Boston Cooperative Studies Program, Boston, MA, USA Dana Farber Cancer Institute, Boston, MA, USA Harvard Medical School, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USAVA North Texas Health Care System, Dallas, TX, USA UT Southwestern School of Medicine, Dallas, TX, USAVA Boston Cooperative Studies Program, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USAVA Boston Cooperative Studies Program, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA Boston University School of Medicine, Boston, MA, USAVA Boston Cooperative Studies Program, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA Boston University School of Medicine, Boston, MA, USAVA Boston Cooperative Studies Program, Boston, MA, USA Harvard Medical School, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USAVA Boston Cooperative Studies Program, Boston, MA, USA Greater Los Angeles VA Healthcare System, Department of Medicine, Los Angeles, CA, USA UCLA David Geffen School of Medicine, Los Angeles, CA, USA VA Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA Abstract Background: COVID-associated pulmonary aspergillosis (CAPA) was described early in the pandemic as a complication of SARS-CoV-2. Data about incidence of aspergillosis and characteristics of affected patients after mid-2021 are limited. Methods: A retrospective, nationwide cohort of US Veterans with SARS-CoV-2 from 1/1/2020 to 2/7/2024 was created. Potential cases of aspergillosis ≤12 weeks of a SARS-CoV-2 test were flagged electronically (based on testing results indicative of invasive fungal infection, antifungal therapy, and/or ICD-10 codes), followed by manual review to establish the clinical diagnosis of pulmonary aspergillosis. Incidence rates were calculated per 10,000 SARS-CoV-2 cases. Selected clinical characteristics included age >70, receipt of immune-compromising drugs, hematologic malignancy, chronic respiratory disease, vaccination status, and vaccine era. Multivariate logistic regression was used to estimate the independent effects of these variables via adjusted odds ratios (aOR). Results: Among 674,343 Veterans with SARS-CoV-2, 165 were electronically flagged for review. Of these, 66 were judged to be cases of aspergillosis. Incidence proportions ranged from 0.30/10,000 among patients with zero risk factors to 34/10,000 among those with ≥3 risk factors; rates were similar in the pre- and post-vaccination eras. The 90-day mortality among aspergillosis cases was 50%. In the multivariate analysis, immune suppression (aOR 6.47, CI 3.84–10.92), chronic respiratory disease (aOR 3.57, CI 2.10–6.14), and age >70 (aOR 2.78, CI 1.64–4.80) were associated with aspergillosis. Conclusions: Patients with underlying risk factors for invasive aspergillosis continue to be at some risk despite SARS-CoV-2 immunization. Risk in patients without immune suppression or preexisting lung disease is very low. https://www.cambridge.org/core/product/identifier/S2732494X24004765/type/journal_article |
| spellingShingle | Kaitlin Swinnerton Nathanael R. Fillmore Ikwo Oboho Janet Grubber Mary Brophy Nhan V Do Paul A Monach Westyn Branch-Elliman Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study |
| title_full | Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study |
| title_fullStr | Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study |
| title_full_unstemmed | Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study |
| title_short | Pulmonary aspergillosis in US Veterans with COVID-19: a nationwide, retrospective cohort study |
| title_sort | pulmonary aspergillosis in us veterans with covid 19 a nationwide retrospective cohort study |
| url | https://www.cambridge.org/core/product/identifier/S2732494X24004765/type/journal_article |
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