The effect of empirical antifungal treatment on the diagnostic sensitivity of galactomannan in bronchoalveolar lavage fluid in chronic obstructive pulmonary disease patients combined with invasive pulmonary aspergillosis / 中华老年医学杂志

ABSTRACT

Objective:To investigate the effect of empirical antifungal treatment on the diagnostic sensitivity of galactomannan(GM)in bronchoalveolar lavage(BALF)in chronic obstructive pulmonary disease(COPD)patients combined with invasive pulmonary aspergillosis(IPA).Methods:COPD patients with IPA were enrolled between January 2015 and January 2019 as research objects.Patients who were treated with antifungal drugs prior to bronchoscopy were considered as the empirical group, and other patients were considered as the diagnosis-driven group.The results of BALF GM were compared between the two groups.Results:A total of 66 COPD patients with IPA were enrolled in this study, with 5 cases confirmed and 61 cases clinically diagnosed.Of them, 17 cases were in the empirical group and 49 in the diagnosis-driven group.There was no significant difference in the sensitivity of blood GM and microbiological examination between the two groups( χ2=0.248 and 0.379, P=0.619 and 0.538). With BALF GM 0.5 as a cutoff value, the sensitivity of BALF GM was slightly lower in the empirical group than in the diagnosis-driven group but with no significant difference(88.2%, 95% CI 62.3%-97.9% vs.93.9%, 95% CI 82.1%-98.4%, χ2=0.051, P=0.821). However, with BALF GM 1.0 as a cutoff value, the sensitivity decreased greatly in the empirical group compared with the diagnosis-driven group(52.9%, 95% CI 28.5%-76.1% vs.80.6%, 95% CI 67.4%-90.8%, χ2=4.036, P=0.045). Logistic regression analysis showed that after adjusting for mechanical ventilation( OR=0.807, 95% CI 0.215-3.026, P=0.750)and use of semisynthetic penicillins( OR=0.498, 95% CI 0.140-1.776, P=0.283), the false negative rate of BALF GM was associated with empirical antifungal therapy( OR=0.243, 95% CI 0.068-0.949, P=0.030). Conclusions:Empirical antifungal therapy prior to bronchoscopy can decrease the diagnostic sensitivity of BALF GM in COPD patients with IPA.