Chest Infections: Infections: Fungal |

Clinical Features of Invasive Bronchial-Pulmonary Aspergillosis in Critically Ill Patients With Chronic Obstructive Pulmonary Diseases FREE TO VIEW

Hong Liu
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Beijing Chaoyang Hospital, Beijing, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A128. doi:10.1016/j.chest.2016.02.133
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SESSION TITLE: Infections: Fungal

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: To describe clinical features of the invasive bronchial-pulmonary aspergillosis (IBPA) in critically ill patients with chronic obstructive pulmonary diseases and evaluate value for early diagnosis and treatment

METHODS: 11 patients diagnosed IBPA with COPD and the double number patients selected from same department and in the similar sex and age grade, which was not suffer from IBPA, were analyzed in a nest case-control study.

RESULTS: 58 critically ill COPD patients were admitted to RICU between February 2007 and December 2008. 11 patients (two cases fulfilled the criteria of proven IBPA, 8 of probable and 1 of possible IBPA) were classified as IBPA group, and 22 COPD patients without IBPA (non-IBPA group) were analyzed.

CONCLUSIONS: Compared to non-IBPA group, higher accumulated doses of prednisone (585±643 mg vs 220±220 mg, P= 0.022) and kinds of antibiotics before ICU admission (2.5 vs 0.33, P= 0.021) were used, duration of antibiotic use (17d vs 0.3d, P= 0.024) was longer in IBPA group. After ICU admission, IBPA patients had a longer invasive ventilation days (12.2d vs 4.5d, P= 0.001), higher mortality (90.9% vs 18.2%, P<0.001), white blood cell count, percent of neutrophilic granulocyte, secrum creatinine and liver enzyme. Dry rales were found more frequently in the lungs of IBPA patients (90.9% vs 45.5%, P= 0.021), respiratory rates were faster (29±8bpm vs 22±8bpm, P=0.026). Logistic regression showed that length of stay in ICU and duration of antibiotic use were the independent risk factors of IBPA​

CLINICAL IMPLICATIONS: Critically ill COPD patients with dry rales in the lungs, elevated WBC count, secrum creatinine and liver enzymes, who were irresponsive to higher doses of corticosteroids and longer duration of antibiotics use may be suspected with IBPA.

DISCLOSURE: The following authors have nothing to disclose: Hong Liu

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