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Risk Factors and Clinical Outcomes of Invasive Fungal Infections in Patients with Severe COVID-19: A Case-Control
Nosheen Nasir1, Syed Abbas Moazzam Kazmi2, Joveria Farooqi3
1Department of Medicine, Aga Khan University, Karachi 74800, Pakistan.
Pathogens (Basel, Switzerland)
|October 29, 2025
Summary
Invasive fungal infections (IFIs) in severe COVID-19 patients significantly increase mortality and prolong hospital stays. Mechanical ventilation is an independent risk factor for developing IFIs.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pulmonology
Background:
- Invasive fungal infections (IFIs) are a significant concern in COVID-19 patients, contributing to increased morbidity and mortality.
- Common IFIs include COVID-19-associated pulmonary aspergillosis (CAPA), candidiasis (CAC), mucormycosis (CAM), and Pneumocystis jirovecii pneumonia (PJP).
Purpose of the Study:
- To investigate the impact of IFIs on clinical outcomes in severe COVID-19 patients.
- To identify independent risk factors associated with IFIs in this population.
Main Methods:
- A case-control study was conducted between March 2020 and April 2022, comparing severe COVID-19 patients with IFIs (cases) to those without IFIs (controls) in a 1:2 ratio.
- Multivariate logistic regression analysis was employed to determine independent risk factors, with adjusted odds ratios (aOR) and 95% confidence intervals (CIs).
Main Results:
- Of 1333 severe COVID-19 patients, 158 (11.8%) had IFIs. Patients with IFIs experienced higher in-hospital mortality (48% vs. control) and longer median hospital stays (14 days vs. 8 days).
- Mechanical ventilation (aOR: 2.5) was independently associated with IFIs. Acute respiratory distress syndrome (ARDS) and hemodialysis were also significantly associated with IFIs on univariate analysis.
Conclusions:
- IFIs are associated with significantly worse outcomes in severe COVID-19 patients, including increased mortality and prolonged hospitalization.
- Mechanical ventilation emerged as a critical independent risk factor for the development of IFIs in severe COVID-19 cases.
Keywords:
COVID-19-associated invasive fungal infectionsICU mortalityaspergillosiscandidiasisinvasive fungal infection (IFIs)invasive mechanical ventilationsevere COVID-19More Related Videos
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