研究背景：肺麴菌症（Pulmonary aspergillosis）為重症呼吸道病毒感染患者的重要續發性感染，其中 COVID-19 相關肺麴菌症（COVID-19-associated pulmonary aspergillosis, CAPA）與流感相關肺麴菌症（Influenza-associated pulmonary aspergillosis, IAPA）均與預後不佳有關。然而，目前針對兩者臨床病程及重症醫療資源使用差異之比較研究仍有限。本研究旨在比較 CAPA 與 IAPA 患者之臨床病程、重症醫療資源使用及臨床預後。
研究方法：本研究為回溯性世代研究，利用成功大學附設醫院電子病歷系統，收集2015年1月1日至2024年8月31日期間因 COVID-19 或流感住院並續發肺麴菌症之患者，共納入63人（CAPA組30人、IAPA組33人）。比較兩組患者之臨床特徵、病毒感染至續發肺麴菌症診斷時間、加護病房（ICU）住院天數、機械通氣使用天數及抗黴菌治療。採用Fisher's exact test及Mann–Whitney U test分析組間差異，並以Kaplan–Meier方法及Log-rank檢定分析存活曲線並同時比較分析院內全死因死亡率。
研究結果：CAPA患者自確診呼吸道病毒至續發肺麴菌症診斷時間顯著長於IAPA患者（16.5天 vs. 8.0天，p<0.001）。CAPA組ICU住院天數亦顯著較長（25.5天 vs. 20.0天，p=0.045），且機械通氣使用天數兩組均呈較長趨勢而無統計上顯著差異。Kaplan–Meier分析顯示兩組續發肺麴菌症後累積存活曲線無顯著差異（Log-rank p=0.52）惟CAPA組前期死亡趨勢較高，兩組長期死亡風險趨於相似。然而，CAPA組院內全死因死亡率仍呈現統計上顯著高於IAPA組（70.0% vs. 36.4%，p=0.011）。
結論：相較於IAPA，CAPA患者具有更漫長的臨床病程、伴隨較高的重症醫療資源使用及較差的整體預後。研究結果顯示，CAPA患者應提高續發肺麴菌症之臨床警覺，及早診斷並適當配置重症醫療資源，以改善重症患者之臨床預後。

Secondary invasive pulmonary aspergillosis is a life-threatening complication of severe viral pneumonia. This study compared the clinical trajectory, critical care resource utilization, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) and influenza-associated pulmonary aspergillosis (IAPA) in mechanically ventilated patients. This retrospective cohort included 63 patients (CAPA, n=30; IAPA, n=33). CAPA showed a significantly delayed onset of secondary aspergillosis compared with IAPA (16.5 vs. 8.0 days, p<0.001) and a significantly longer intensive care unit (ICU) stay (25.5 vs. 20.0 days, p=0.045), with a trend toward longer mechanical ventilation. Kaplan–Meier analysis showed no significant difference in cumulative survival after aspergillosis diagnosis (log-rank p=0.52); however, all-cause mortality was significantly higher in CAPA than in IAPA (70.0% vs. 36.4%, p=0.011). These findings indicate that CAPA follows a more prolonged clinical trajectory, consumes greater critical care resources, and is associated with poorer overall outcomes than IAPA. Early recognition of secondary fungal infection and appropriate critical care resource allocation are therefore particularly important in CAPA.

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