Repeated Aspergillusisolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infectionReport as inadecuate




Repeated Aspergillusisolation in respiratory samples from non-immunocompromised patients not selected based on clinical diagnoses: colonisation or infection - Download this document for free, or read online. Document in PDF available to download.

BMC Infectious Diseases

, 12:295

Bacterial and fungal diseases

Abstract

BackgroundIsolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis infection vs. colonisation, treatment administration or not of antifungals and prognosis mortality in non-transplant-non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples.

MethodsRecords of adult patients 29 Spanish hospitals presenting ≥2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven histopathological confirmation or probable aspergillosis new respiratory signs-symptoms with suggestive chest imaging or colonisation symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates. Logistic regression models step–wise were performed using Aspergillosis probable + proven, antifungal treatment and mortality as dependent variables. Significant p < 0.001 models showing the highest R were considered.

ResultsA total of 245 patients were identified, 139 56.7% with Aspergillosis. Aspergillosis was associated R = 0.291 with ICU admission OR = 2.82, congestive heart failure OR = 2.39 and steroids pre-admission OR = 2.19 as well as with cavitations in X-ray-CT scan OR = 10.68, radiological worsening OR = 5.22 and COPD exacerbations-need for O2 interaction OR = 3.52. Antifungals were administered to 79.1% patients with Aspergillosis 100% proven, 76.8% probable and 29.2% colonised, with 69.5% patients receiving voriconazole alone or in combination. In colonised patients, administration of antifungals was associated with ICU admission at hospitalisation OR = 12.38. In Aspergillosis patients its administration was positively associated R = 0.312 with bronchospasm OR = 9.21 and days in ICU OR = 1.82 and negatively with Gold III + IV OR = 0.26, stroke OR = 0.024 and quinolone treatment OR = 0.29. Mortality was 78.6% in proven, 41.6% in probable and 12.3% in colonised patients, and was positively associated in Aspergillosis patients R = 0.290 with radiological worsening OR = 3.04, APACHE-II OR = 1.09 and number of antibiotics for treatment OR = 1.51 and negatively with species other than A. fumigatus OR = 0.14 and aspergillar tracheobronchitis OR = 0.27.

ConclusionsAdministration of antifungals was not always closely linked to the diagnostic categorisation colonisation vs. Aspergillosis, being negatively associated with severe COPD GOLD III + IV and concomitant treatment with quinolones in patients with Aspergillosis, probably due to the similarity of signs-symptoms between this entity and pulmonary bacterial infections.

KeywordsAspergillus COPD Clinical management Aspergillosis AbbreviationsAPACHEAcute physiologic and chronic health evaluation

COPDChronic obstructive pulmonary disease

GOLDGlobal initiative for chronic obstructive lung disease

ICUIntensive care unit

NYHANew York heart association

OROdds ratio.

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Author: Jose Barberan - Bernardino Alcazar - Eduardo Malmierca - Francisco Garcia de la Llana - Jordi Dorca - Daniel del Castillo -

Source: https://link.springer.com/







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