The reported prevalence of CAPA in ICU patients with COVID-19 varies greatly by study and may be related to surveillance protocols and inconsistent definitions which may inflate the prevalence of this complication.

Further research should refine COVID-19-associated pulmonary aspergillosis (CAPA) definitions and identify patients most likely to benefit from pre-emptive antifungal therapy.

51 studies were included.

Among 3,297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA.

277 patients had patient-level data allowing reclassification.

Definitions had limited correlation with one another with the exception of Koehler and Verweij.

33.9% of patients reported to have CAPA did not fulfill any research definitions.

Patients were diagnosed after a median of 8 days (interquartile range 5-14) in ICUs.

Tracheobronchitis occurred in 3% of patients examined with bronchoscopy.

The mortality rate was high (59.2%).

Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival.

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