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Purpose: COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment., Materials and Methods: A retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria., Results: CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy., Conclusions: CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation., Competing Interests: Declaration of Competing Interest Paul Verweij: Institution contracted for research grant: F2G and Gilead Sciences; Honoraria for lectures paid to institution: F2G, Gilead Sciences, Pfizer; Participation on a Data Safety Monitoring Board or Advisory Board paid to institution: F2G, Mundipharma. Roger Brüggeman: Institution contracted for research grant: Astellas Pharma, Inc., Gilead Sciences, Merck Sharp & Dohme Corp., Pfizer; Consulting fees paid to institution: Astellas Pharma, Inc., F2G, Amplyx, Gilead Sciences, Merck Sharp & Dohme Corp., Mundipharma, Pfizer. Joost Wauters: Investigator-initiated grants: Gilead, MSD, Pfizer; Consulting fees: Investigator-initiated grants from Gilead, Pfizer; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: Speakers fees from Gilead, Pfizer; Support for attending meetings and/or travel: travel grants from Gilead and Pfizer. No potential financial or non-financial competing interest was reported by any of the other authors., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

We performed an observational study to investigate intensive care unit incidence, risk factors, and outcomes of coronavirus disease-associated pulmonary aspergillosis (CAPA). We found 10%-15% CAPA incidence among 823 patients in 2 cohorts. Several factors were independently associated with CAPA in 1 cohort and mortality rates were 43%-52%.