Changing clinical spectrum and hospital burden of pulmonary aspergillosis before and during the COVID-19 era: a 15-year single-center retrospective study

Background Pulmonary aspergillosis (PA) encompasses a heterogeneous spectrum of fungal diseases, including invasive, chronic, and allergic forms. The hospital burden and clinical characteristics of PA during the COVID-19 era remain incompletely understood. Methods We conducted a single-center retrospective study of hospitalized patients diagnosed with PA at a tertiary hospital in northern Anhui Province, China, between January 1, 2010, and December 31, 2024. Temporal trends, clinical characteristics, microbiological findings, diagnostic indicators, treatment timing, and short-term clinical outcomes were analyzed. Patients were compared between the pre-COVID-19 period and the COVID-19 era. Results A total of 378 hospitalized PA cases were included. The annual number of PA cases increased over the study period, with a more pronounced increase during the COVID-19 era than during the pre-COVID-19 period, corresponding to an average annual increase of 35.2 cases versus 1.49 cases, respectively. Aspergillus fumigatus was the predominant identified species, accounting for 54.87% of isolates. Compared with patients in the pre-COVID-19 period, those in the COVID-19 era were older [median age: 62.00 years, interquartile range (IQR): 54.00–72.00 vs. 54.00 years, IQR: 46.00–69.00; Z = − 2.814, P = 0.005] and had a shorter interval from symptom onset to initiation of antifungal therapy [12.00 days, IQR: 7.00–19.00 vs. 19.00 days, IQR: 10.60–32.00; Z = − 3.724, P = 0.001]. Serum (1,3)-β-D-glucan levels were higher in the COVID-19 era group than in the pre-COVID-19 group [37.50 pg/mL, IQR: 37.50–100.97 vs. 28.60 pg/mL, IQR: 10.00–88.43; Z = − 2.644, P = 0.008]. In univariate logistic regression analysis, influenza-associated pulmonary aspergillosis, hematological malignancy, mechanical ventilation, ICU admission, and GM index > 0.5 were associated with poor clinical outcome. Multivariable analysis identified hematological malignancy and ICU admission as independent factors associated with poor clinical outcome [odds ratio (OR): 3.340, 95% confidence interval (CI): 1.286–8.674, P = 0.013; OR: 5.861, 95% CI: 2.715–12.652, P < 0.001, respectively]. Conclusion The hospital burden of PA increased during the COVID-19 era in this single-center cohort, accompanied by older patient age and earlier initiation of antifungal therapy. Hematological malignancy and ICU admission were the strongest factors associated with poor short-term clinical outcome. Further analyses stratified by PA subtype are warranted to better define prognosis across invasive, chronic, and allergic forms of aspergillosis.