Active surveillance of cytomegalovirus and pulmonary aspergillosis in critically ill patients with COVID-19: risk assessment of high-dose steroids

Opportunistic infections such as cytomegalovirus (CMV) and COVID-19-associated pulmonary aspergillosis (CAPA) pose major risks in critically ill COVID-19 patients, particularly those receiving high-dose corticosteroids. We conducted weekly active surveillance for CMV and Aspergillus in 210 ICU-admitted patients with severe COVID-19. Incidence, timing, and risk factors were assessed, with a focus on corticosteroid dose. Inverse probability of treatment weighting (IPTW)-adjusted logistic regression and Kaplan–Meier survival analyses were applied. CMV DNAemia (≥ 1000 copies/mL) occurred in 29.0% of patients, peaking during weeks 3–4. CAPA (possible + probable) occurred in 14.3% and peaked earlier, within the first two weeks. High-dose corticosteroid use was associated with significantly increased risks of CMV DNAemia (aOR 5.34; 95% CI, 2.69–10.58) and CAPA (aOR 2.28; 95% CI, 1.22–4.25). CMV and CAPA occurred in distinct temporal patterns, with CMV reactivation peaking later in the ICU course. High-dose corticosteroids significantly increased the risk of both infections, underscoring the need for tailored surveillance strategies during intensive care. Not applicable.