Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU

<b>Rationale:</b> Whether severe coronavirus disease (COVID-19) is a significant risk factor for the development of invasive fungal superinfections is of great medical interest and remains, for now, an open question.<b>Objectives:</b> We aim to assess the occurrence of invasive fungal respiratory superinfections in patients with severe COVID-19.<b>Methods:</b> We conducted the study on patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia admitted to five ICUs in France who had respiratory and serum sampling performed for specific screening of fungal complications.<b>Measurements and Main Results:</b> The study population included a total of 145 patients; the median age was 55 years old. Most of them were male (<i>n</i> = 104; 72%), were overweight (<i>n</i> = 99; 68%), and had hypertension (<i>n</i> = 83; 57%) and diabetes (<i>n</i> = 46; 32%). Few patients presented preexisting host risk factors for invasive fungal infection (<i>n</i> = 20; 14%). Their global severity was high; all patients were on invasive mechanical ventilation, and half (<i>n</i> = 73, 54%) were on extracorporeal membrane oxygenation support. Mycological analysis included 2,815 mycological tests (culture, galactomannan, β-glucan, and PCR) performed on 475 respiratory samples and 532 sera. A probable/putative invasive pulmonary mold infection was diagnosed in 7 (4.8%) patients and linked to high mortality. Multivariate analysis indicates a significantly higher risk for solid organ transplant recipients (odds ratio, = 4.66; interquartile range, 1.98-7.34; <i>P</i> = 0.004). False-positive fungal test and clinically irrelevant colonization, which did not require the initiation of antifungal treatment, was observed in 25 patients (17.2%).<b>Conclusions:</b> In patients with no underlying immunosuppression, severe SARS-CoV-2-related pneumonia seems at low risk of invasive fungal secondary infection, especially aspergillosis.