- 作者：Jose Barberan ; Francisco Sanz ; Jose-Luis Hern ; ez ; Silvia Merlos ; Eduardo Malmierca ; Francisco-Javier Garcia-Perez ; Eloy Sanchez-Haya ; Mar Segarra ; Francisco Garcia de la Llana ; Juan-Jose Granizo ; Maria-Jose Gimenez ; Lorenzo Aguilar
- 关键词：Invasive pulmonary aspergillosis ; Chronic obstructive pulmonary disease ; GOLD stage
- 刊名：Journal of Infection
- 出版年：2012
- 出版时间：November, 2012
- 年：2012
- 卷：65
- 期：5
- 页码：447-452
- 全文大小：182 K
Summary
Objective
To explore clinical features of invasive pulmonary aspergillosis (IPA) vs. colonization among hospitalized COPD patients.Methods
Records of COPD patients with two respiratory cultures yielding Aspergillus were retrospectively reviewed. Cases categorized as proven/probable IPA or colonization was analyzed.
Results
118 patients were identified: 70 (59.3 % ) colonized, 48 (40.7 % ) with IPA (42 probable, 6 proven). Higher percentage of IPA patients (vs. colonized) presented GOLD III?+?IV (77.1 % vs. 57.1 % , p?=?0.025). IPA patients presented higher Charlson index (3.5?¡À?2.5 vs. 2.6?¡À?2.2, p?=?0.027), higher rate of ICU admission (27.1 % vs. 4.3 % , p?=?0.001) and worse prognosis (McCabe rapidly fatal category: 31.3 % vs. 7.1 % , p?=?0.001). GOLD-I IPA patients presented risk factors other than COPD. Before hospitalization, 66.7 % IPA and 28.6 % colonized patients were taking steroids (p?<?0.001). Antifungals were administered to 83.3 % IPA and 21.4 % colonized patients (p?<?0.001). Mortality was higher among IPA vs. colonized patients, both in global (58.3 % vs. 10.0 % , p?<?0.001), GOLD-I (75.0 % vs. 10.0 % , p?=?0.041), GOLD-II (42.9 % vs. 5.0 % , p?=?0.042) and GOLD-III patients (54.2 % vs. 0.0 % , p?<?0.001), but not in GOLD-IV patients (69.2 % vs. 31.3 % , p?=?0.066).
Conclusions
IPA should be suspected not only in GOLD-III and GOLD-IV COPD patients, with higher mortality in IPA vs. colonized patients for GOLD-II and -III COPD patients.