PURPOSE: To determine the value of Aspergillus culture of lower respiratory tract (LRT) samples in diagnosing COPD with IPA.
METHODS: We retrospectively collected the clinical data of patients with positive culture LRT samples for Aspergillus spp. in COPD or immunosuppression in a tertiary hospital from January 2007 to January 2011. IPA diagnosis was based on the criteria defined by the EORTC/MSG.
RESULTS: 1. 86 COPD patients (36 patients in ICU and 50 patients in general ward) were classified as proven IPA (n=5), probable IPA (n=29), or colonization (n=52), and 44 immunocompromised patients were classified as probable IPA (n=24) and colonization (n=20). 2. Multivariate statistical analysis showed that APACHE II scores>18, high accumulated doses of corticosteroids (>350mg) and more than four kinds of broad-spectrum antibiotics received in hospital were significant predictors of IPA in COPD (OR=1.208, P<0.001; OR=1.003, P=0.046; OR=1.606; P=0.036, respectively). 3. Compared with the patients in general ward, ICU patients had a higher incidence of IPA, overall mortality, IPA mortality and colonization mortality (66.7% vs 20%, P<0.001; 69.4% vs 16%, P<0.001; 83.3% vs 50%, P=0.085 and 41.7% vs 7.5%; P=0.004, respectively). 4. There were no statistically significant differences between COPD and immunocompromised patients in IPA incidence, overall mortality, IPA mortality and colonization mortality (39.5% vs 54.5%, P=0.103; 38.4% vs 61.6%, P=0.306; 73.5% vs 66.7%, P=0.572 and 15.4% vs 25%, P=0.342, respectively).
CONCLUSIONS: The positive LRT samples for Aspergillus is valuable in diagnosis of IPA and indicates poor prognosis for COPD patients with high APACHE II scores (>18), high accumulated doses of corticosteroids (>350mg) and more than four kinds of broad-spectrum antibiotics received in hospital, particularly for ICU patients.
CLINICAL IMPLICATIONS: The finding of Aspergillus spp. positive lower respiratory tract samples in COPD patients with APACHE II scores higher than 18, accumulated doses of corticosteroids more than 350 mg and more than four kinds of broad-spectrum antibiotics received in hospital, particularly in ICU patients, cannot be discarded and must prompt further diagnostic assessment.
DISCLOSURE: The following authors have nothing to disclose: Shuo Chang, Hangyong He, Ding Lin, Fang Li, Bing Sun, Qingyuan Zhan
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