Influenza-related invasive pulmonary aspergillosis in an infectious disease ward at a pulmonary referral center in Iran

Influenza-associated invasive pulmonary aspergillosis (IPA) is a known complication of influenza in the intensive care unit (ICU) but limited information is evident for non-ICU patients. In this cross-sectional study, we retrospectively collected electronic medical records of all patients admitted to the medical infectious disease ward who had confirmed influenza and met the criteria for invasive aspergillosis. This study recruited patients between September 2023 to May 2024 from the Masih Daneshvari Educational Pulmonary Referral Center in Iran. Among 109 patients with confirmed influenza, 10 were diagnosed with IPA. Our findings indicated that the odds of death were significantly higher in patients with IPA compared to those without it (Odds Ratio [OR] = 20.78, 95% Confidence Interval [CI] [2.97 to 145.61], P = 0.005). The rate of bacterial co-infections was also elevated in patients with IPA compared to those without (OR = 4.7, 95% CI [1.22 to 18.01], P = 0.025). Patients with IPA had a greater likelihood of being transferred to the ICU (OR = 3.4, 95% CI [0.77 to 15.2], P = 0.118). They experienced longer hospital stays, with a median duration of 19.5 days (Interquartile Range [IQR] [11.7–26.5]) compared to 7 days (IQR [6–12]) for those without IPA (Z = -3.8, P < 0.001). Furthermore, patients with IPA had a significantly higher likelihood of having underlying lung disease compared to their counterparts without IPA (OR = 67, 95% CI [1.3 to 33.3], P = 0.015). This study found that IPA is a lethal complication of influenza among non-ICU patients with Influenza.