Risk factors for pulmonary fungal infection associated with chronic obstructive pulmonary disease and clinical efficacy of itraconazole / 中国感染控制杂志

ABSTRACT

Objective To study the risk factors for pulmonary fungal infection associated with chronic obstructive pulmonary disease (COPD),and evaluate the efficacy and safety of itraconazole for treatment of pulmonary fungal infection associated COPD.Methods A retrospective analysis were conducted on clinical data of 42 COPD patients who were confirmed pulmonary fungal infection in a respiratory disease department from September 1 ,2007 to May 31 ,2012,and 53 COPD patients who had no pulmonary fungal infection were as control.Results Of 42 patients with COPD and pulmonary fungal infection,8 were confirmed by histopathological examination,34 were confirmed by clinical diagnosis;6 were acute cases,36 were chronic cases;28 were positive for fungal detection,6 of whom were detected Candida albicans ,13 were detected Aspergillus ,7 were detected unclassified fungi,and 2 had mixed fungal infection.Univariate analysis showed that underlying diseases,long-term use of broad-spectrum antimicrobi-als,long-term use of glucocorticoid,hypoproteinemia,invasive procedure,invasive mechanical ventilation,diabetes mellitus,history of invasive fungal infection were major risk factors for pulmonary fungal infection associated with COPD.After patients were treated by itraconazole,the improvement rate of clinical symptoms was 66.67%,fungal eradication rate was 60.71 %,total effective rate was 64.29%.Of 28 cases with positive fungal detection,the im-provement rate of clinical symptoms,fungal eradication rate,and total effective rate was 71 .43%(n=20),60.71 %(n=17),and 67.86%(n=19)respectively.Itraconazole had good therapeutic efficacy on acute and chronic pulmo-nary fungal infection associated with COPD.Adverse drug reaction rate was 23.81 %,most were mild and reversi-ble,and had no obvious impact on the treatment.Conclusion Itraconazole has positive clinical efficacy on treating pulmonary fungal infection associated with COPD,it is highly safe.