Frontiers in cellular and infection microbiology · 2026
Detection of Aspergillus in the lower respiratory tract and its association with mortality in patients with different viral pneumonias: a retrospective multicenter cohort study from China.
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Li Xiaohua, He Xinwei, Fu Xufeng, Wu Nan, Yang Deqing, Zhao Jin, Ma Xinqian, Chai Shukun, Ni Wentao
Аннотация
BACKGROUND: The detection of Aspergillus in the lower respiratory tract complicates the clinical course of viral pneumonia and is linked to poor outcomes, but prior evidence is confined to the intensive care unit (ICU) or single-virus settings (e.g., influenza or SARS-CoV-2). Whether its frequency and prognostic significance differ across viral etiologies in hospitalized adults remains unknown.
METHODS: This multicenter retrospective cohort study included adults with community-acquired viral pneumonia at seven tertiary hospitals in China (2017-2025). Patients were categorized into SARS-CoV-2, influenza, or other viral groups. The exposure was lower respiratory tract Aspergillus detection (via using culture, real-time PCR, or metagenomic next-generation sequencing). The primary outcome was in-hospital all-cause mortality.
RESULTS: Among 929 patients, Aspergillus was detected in 175 (18.8%). The detection rates differed significantly across viral etiologies (33.2% in patients with influenza, 14.6% in those with SARS-CoV-2, and 7.4% in those with other viruses; P < 0.001). In the fully adjusted model, Aspergillus detection was independently associated with increased overall mortality (aOR = 2.99; 95% CI 1.60-5.58; P < 0.001), but the association varied markedly by viral etiology. Virus-stratified analyses revealed that in influenza, Aspergillus detection remained independently associated with mortality after multivariable adjustment, and the association was consistently observed across prespecified subgroups, including non-ventilated patients, whereas in SARS-CoV-2, the association was largely confined to ventilated patients.
CONCLUSION: Lower respiratory tract Aspergillus detection differed substantially by viral etiology and was most frequent in patients with influenza pneumonia. It was independently associated with increased mortality across all influenza subgroups, including non-ventilated patients, whereas in SARS-CoV-2 pneumonia this association was largely confined to mechanical ventilation patients. These findings support a virus-stratified approach to fungal surveillance and warrant prospective validation.
METHODS: This multicenter retrospective cohort study included adults with community-acquired viral pneumonia at seven tertiary hospitals in China (2017-2025). Patients were categorized into SARS-CoV-2, influenza, or other viral groups. The exposure was lower respiratory tract Aspergillus detection (via using culture, real-time PCR, or metagenomic next-generation sequencing). The primary outcome was in-hospital all-cause mortality.
RESULTS: Among 929 patients, Aspergillus was detected in 175 (18.8%). The detection rates differed significantly across viral etiologies (33.2% in patients with influenza, 14.6% in those with SARS-CoV-2, and 7.4% in those with other viruses; P < 0.001). In the fully adjusted model, Aspergillus detection was independently associated with increased overall mortality (aOR = 2.99; 95% CI 1.60-5.58; P < 0.001), but the association varied markedly by viral etiology. Virus-stratified analyses revealed that in influenza, Aspergillus detection remained independently associated with mortality after multivariable adjustment, and the association was consistently observed across prespecified subgroups, including non-ventilated patients, whereas in SARS-CoV-2, the association was largely confined to ventilated patients.
CONCLUSION: Lower respiratory tract Aspergillus detection differed substantially by viral etiology and was most frequent in patients with influenza pneumonia. It was independently associated with increased mortality across all influenza subgroups, including non-ventilated patients, whereas in SARS-CoV-2 pneumonia this association was largely confined to mechanical ventilation patients. These findings support a virus-stratified approach to fungal surveillance and warrant prospective validation.