# Risk factors for invasive mold infection after COVID-19: case-control study

## TL;DR

This study identifies steroid use as a major risk factor for invasive mold infections in severe COVID-19 patients, which are linked to higher mortality.

## Contribution

The study highlights the association between steroid use and invasive mold infections in severe COVID-19, offering clinical guidance on steroid management.

## Key findings

- Steroid use was strongly associated with invasive mold infections (OR: 25.712, p=0.009).
- Invasive aspergillosis was more common than mucormycosis among infected patients.
- 28-day mortality was significantly higher in the invasive mold infection group (60.0%) compared to the control group (15.8%).

## Abstract

Invasive mold infections (IMI) have become common in patients with severe COVID-19 pneumonia, which are difficult to diagnose and treat, with a high mortality rate.

The aim of this study was to determine risk factors for invasive mold infections associated with COVID-19.

In this prospective, case-control study, patients treated for severe COVID-19 pneumonia in intensive care units with invasive mold infection were compared with severe COVID-19 pneumonia patients with no secondary infection (bacterial or fungal). Demographics, treatments received and outcomes were compared.

Twenty patients were included in the IMI group and 19 patients in the control group. Invasive aspergillosis was observed in 13 patients (65.0%) while mucormycosis was observed in seven patients (35.0%). Demographics and clinical characteristics were similar between IMI and control group (p>0.005). The 28-day mortality was 60.0% in the IMI group and 15.8% in the control group (p=0.005). The use of steroids has been identified as the most important risk factor for developing IMI (90.0% vs. 15.8%, OR: 25.712, p=0.009).

Rationale use of steroids, with appropriate indication, dose and duration is important in the treatment of severe COVID-19 pneumonia.