{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:55:56Z","timestamp":1793094956932,"version":"4.5.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017962","name":"Jiangsu Commission of Health","doi-asserted-by":"publisher","award":["\u62e8\u6b3e\u7f16\u53f7\u3002BJ24037"],"award-info":[{"award-number":["\u62e8\u6b3e\u7f16\u53f7\u3002BJ24037"]}],"id":[{"id":"10.13039\/100017962","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Co-infection with\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      and\n                      <jats:italic>Mucorales<\/jats:italic>\n                      in the intensive care unit (ICU) represents a devastating syndrome with high mortality that is frequently clinically occult. Clinically distinguishing this co-infection from invasive pulmonary aspergillosis (IPA) is challenging but critical for tailoring precise antifungal strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a single-center, retrospective observational study involving 93 critically ill patients (75 with\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      infection and 18 with co-infection) admitted between 2017 and 2025. We compared clinical characteristics, inflammatory markers, and immunophenotypes between groups. A three-stage variable selection strategy integrating univariable regression pre-screening, multi-algorithm importance ranking (LASSO, Ridge, and Random Forest), and clinical applicability filtering was employed to identify predictors for a multivariable logistic regression nomogram.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The co-infection group exhibited substantially higher ICU mortality than the sole\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      group, although the difference did not reach statistical significance (72.2% vs. 53.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.24).Kaplan\u2013Meier analysis demonstrated that initiation of amphotericin B within &amp;lt;7 days of diagnosis or strong clinical suspicion was significantly associated with improved survival (log-rank\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.0001). A three-stage variable selection strategy integrating univariable regression, multi-algorithm importance ranking (LASSO, Ridge, and Random Forest), and clinical applicability filtering identified four key predictors. The resulting multivariable logistic regression nomogram \u2014 incorporating NK cell count, C-reactive protein, corticosteroid use history, and Gram-positive bacterial co-infection \u2014 demonstrated robust discrimination (AUC\u00a0=\u00a00.878, 95% CI: 0.789\u20130.967), with good calibration (Hosmer\u2013Lemeshow\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.849) and stability on internal validation (cross-validated AUC\u00a0=\u00a00.860).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      and\n                      <jats:italic>Mucorales<\/jats:italic>\n                      co-infection constitutes a distinct, high-mortality clinical entity in the ICU. The developed nomogram, integrating clinical, immunological, and inflammatory features, may facilitate the early identification of high-risk patients and guide timely initiation of\n                      <jats:italic>Mucorales<\/jats:italic>\n                      -active therapy to improve prognosis.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1779186","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T05:47:59Z","timestamp":1776836879000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Confronting the \u201clethal duo\u201d in the ICU: early identification of Aspergillus\u2013Mucorales co-infection using a clinical-immuno-inflammatory signature"],"prefix":"10.3389","volume":"16","author":[{"given":"Hongqiang","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University","place":["Nanjing, China"]},{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxu","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Peking University Shenzhen Hospital","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjie","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengwen","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghui","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baoxia","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital, Clinical College of Xuzhou Medical University","place":["Nanjing, China"]},{"name":"Department of Intensive Care Unit, Nanjing Drum Tower Hospital","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.59007","article-title":"C-reactive protein kinetics during in-patient treatment of COVID-19-associated rhino-orbito-cerebral mucormycosis: a retrospective cohort study in a tertiary hospital in Central India","volume":"16","author":"B. 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