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Background The literature regarding COVID-19 associated pulmonary aspergillosis (CAPA) has shown conflicting observations, including survival of CAPA patients not receiving antifungal therapy and discrepancy between CAPA diagnosis and autopsy findings. To gain insight into the pathophysiology of CAPA we performed a case-control study, in which we compared Aspergillus test profiles in CAPA patients and controls in relation to ICU-mortality. Methods A multinational case-control study, in which Aspergillus test results, use of antifungal therapy and mortality were collected from critically-ill COVID-19 patients. Patients were classified using the 2020 ECMM/ISHAM consensus case definitions. Results 219 critically-ill COVID-19 cases were analyzed, including one proven, 38 probable, 19 possible CAPA cases, 21 Aspergillus colonized patients, seven patients only positive for serum (1, 3)-ß-D-glucan (BDG), and 133 cases with no evidence of CAPA. Mortality was 53.8% in CAPA patients compared to 24.1% in patients without CAPA (p=0.001). Positive serum galactomannan (GM) and BDG were associated with increased mortality compared to serum biomarker negative CAPA patients (87.5% versus 41.7%, p=0.046; 90.0% versus 42.1%, p=0.029, respectively). For each point increase in GM or ten-point BDG serum concentration, the odds of death increased (GM, OR 10.208, 95%CI 1.621-64.291, p=0.013; BDG, OR 1.247, 95%CI 1.029-1.511, p=0.024). Conclusions CAPA is a complex disease, probably involving a continuum of respiratory colonization, tissue-invasion and angioinvasion. Serum biomarkers are useful for staging CAPA disease progression and, if positive, indicate angioinvasion and a high probability of mortality. There is need for a biomarker that distinguishes between respiratory tract colonization and tissue invasive CAPA disease.

Background: The objective of this study was to determine the level of environmental contamination in hospitals in the Dutch/Belgian border area, using ATP measurements. Design: A cross-sectional observational survey. Methods: Standardized ATP measurements were conducted in 9 hospitals on 32 hospital wards. Thirty pre-defined surfaces per hospital ward were measured with the 3 M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU > 1000 was considered as "not clean." Differences in RLU values were compared between countries, hospitals, fomite groups and medical specialties. Results: A total of 960 ATP measurements were performed, ranging from 60 up to 120 per hospital. The median RLU-value was 568 (range: 3-277,586) and 37.7% of the measurements were rated as not clean (RLU > 1000). There were significant differences between countries, hospitals and fomite groups. Conclusion: ATP measurements can be used as a more objective approach to determine the level of environmental contamination in hospitals. Significant differences in ATP levels were found between hospitals and between countries. Also, substantial differences were found between different fomite groups. These findings offer potential targets for improvement of cleanliness in healthcare facilities.