Clinical features and risk factors of invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease / 中华临床感染病杂志

ABSTRACT

Objective:To analyze the clinical features and risk factors of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD).Methods:Ninety COPD patients with IPA admitted in the First Affiliated Hospital, Zhejiang University School of Medicine and Zhejiang Provincial People’s Hospital from January 2015 to September 2019 were enrolled, and 180 COPD patients without IPA admitted in the same period were selected as control group. The clinical data of the patients in both groups were analyzed retrospectively. Chi square test was used to compare the imaging characteristics of patients in two groups, and multivariate conditional Logistic regression analysis was used to explore the risk factors of IPA in COPD patients. Results:Among 90 cases of COPD with IPA, the culture of lower respiratory tract samples identified Aspergillus fumigatus in 78 cases, Aspergillus flavus in 6 cases, Aspergillus fumigatus with Aspergillus flavus in 1 case, Aspergillu sterrus in 1 case, and Aspergillus nigerwere in 1 case; 1 case of Aspergillus mycelium was found by sputum exfoliation cytology and 2 cases were positive for serum galactomannan. Chest CT images showed patchy infiltrating shadow (87.8%), pleural effusion (36.7%), nodules (33.3%), cavity (18.9%), consolidation shadow (17.8%), halo sign (14.4%) and air crescent sign (2.2%). The incidence of patchy infiltrating shadow, consolidation shadow, halo sign and cavity were higher in COPD patients with IPA compared to control group ( P<0.05 or P<0.01). Multivariate conditional Logistic regression analysis showed that prolonged hospital stay ( OR=1.183, 95% CI 1.047-1.336), combination of two antibiotics ( OR=5.391, 95% CI 1.241-23.421), duration of antibiotic treatment ≥14 days ( OR=5.275, 95% CI 1.586-17.541), cumulative use of antibiotics ( OR=2.270, 95% CI 1.406-3.664) were the risk factors of COPD with IPA ( P<0.05 or P<0.01). Conclusion:The risk factors of IPA in COPD patients include long duration of hospital stay, combination of two kinds of antibiotics, more than 14 days of antibiotic treatment, and more varieties of antibiotics. If the above risk factors exist in patients with COPD, etiology and serology examination and dynamic monitoring of chest CT scan should be performed for early diagnosis and improved prognosis.