Clinical characteristics of patients with positive fungal pathogens during acute exacerbation of chronic obstructive pulmonary disease: A retrospective study

Lijuan Luo , Lijun Liu , Yiming Ma , Herui Li , Zihang Zeng , Yan Chen
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Abstract

Background

Fungal infections in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients are poorly understood and often result in a poor prognosis. This study aimed to investigate the distribution of common fungi and the clinical features of AECOPD patients positive for fungal pathogens.

Methods

Data were collected from inpatients with AECOPD at the Second Xiangya Hospital of Central South University from January 2016 to December 2019. The enrolled patients were divided into an infection group and a colonization group, and clinical data were compared between the two groups. A 1:1 propensity score matching (PSM) process was employed to ensure balanced samples to analyze the impact of positive fungal pathogens on the clinical features of AECOPD patients. The incidence of acute exacerbations one year after discharge was determined via telephone follow-up.

Results

The most frequently isolated fungal pathogen was Candida albicans (164/395, 41.5 %), followed by Aspergillus (93/395, 23.5 %). After propensity score matching, 68 patients were equally divided into the infection and colonization groups. There was no significant difference in clinical manifestations between the infection and colonization groups (P > 0.05). Patients in the infection group had significantly higher procalcitonin (PCT) values (0.2 [0.1, 0.7] ng/ml vs. 0.1 [0, 0.1] ng/ml; P = 0.003) and lower albumin/globulin ratios (1.1 [0.6, 1.3] vs. 1.1 [1.0, 1.3], P = 0.047) than those in the colonization group. The antibiotic treatment (12.5 [11.0, 19.0] days vs. 10.0 [8.0, 14.0] days; P = 0.002) and hospitalisation duration (18.0 [14.7, 22.5] days vs. 11.0 [8.0, 16.0] days; P < 0.001) in the infection group was significantly longer than that in the colonization group. In addition, more patients in the colonization group received non-invasive mechanical ventilation (76.5 % [26/34] vs. 47.1 % [16/34]; P = 0.013). Compared with the colonization group, more patients in the infection group underwent bronchoscopy (29.4 % [10/34] vs. 2.9 % [1/34]; P = 0.003). Using multivariable analysis, we found that bronchoscopy (OR: 1.350, 95 % CI: 1.020–1.771, P = 0.034) and duration of antibiotics used (OR: 1.318, 95 % CI: 1.090–1.560, P = 0.004) were risk factors for pulmonary fungal infection in AECOPD patients.

Conclusion

Candida albicans and Aspergillus are the common fungi isolated from patients with AECOPD. The clinical manifestations of AECOPD patients with fungal infection are nonspecific. AECOPD patients with positive fungal isolation who have undergone bronchoscopy and used antibiotics for a longer duration are more likely to have fungal infection.
慢性阻塞性肺疾病急性加重期真菌病原体阳性患者的临床特征:一项回顾性研究
慢性阻塞性肺疾病急性加重期(AECOPD)患者的真菌感染尚不清楚,且往往导致预后不良。本研究旨在探讨真菌病原菌阳性AECOPD患者的常见真菌分布及临床特征。方法收集2016年1月至2019年12月中南大学湘雅第二医院住院AECOPD患者的数据。将入组患者分为感染组和定植组,比较两组患者的临床资料。采用1:1倾向评分匹配(PSM)方法确保样本平衡,分析真菌病原体阳性对AECOPD患者临床特征的影响。出院后1年急性加重发生率通过电话随访确定。结果最常见的真菌病原菌为白色念珠菌(164/395,41.5 %),其次为曲霉(93/395,23.5 %)。经倾向评分匹配后,68例患者平均分为感染组和定植组。感染组与定植组的临床表现差异无统计学意义(P >; 0.05)。感染组患者降钙素原(PCT)值显著升高(0.2 [0.1,0.7]ng/ml vs. 0.1 [0,0.1] ng/ml;P = 0.003),白蛋白/球蛋白比值(1.1 [0.6,1.3]vs. 1.1 [1.0, 1.3], P = 0.047)低于定殖组。抗生素治疗组(12.5 [11.0,19.0]d vs. 10.0 [8.0, 14.0] d;P = 0.002)和住院时间(18.0[14.7,22.5]天vs. 11.0[8.0, 16.0]天;P <; 0.001),感染组明显长于定殖组。此外,定植组更多患者接受无创机械通气(76.5% % [26/34]vs. 47.1% % [16/34]; = 0.013页)。与定植组相比,感染组接受支气管镜检查的患者较多(29.4 % [10/34]vs. 2.9 % [1/34]; = 0.003页)。通过多变量分析,我们发现支气管镜检查(OR: 1.350, 95 % CI: 1.020-1.771, P = 0.034)和抗生素使用时间(OR: 1.318, 95 % CI: 1.090-1.560, P = 0.004)是AECOPD患者肺部真菌感染的危险因素。结论白色念珠菌和曲霉菌是AECOPD患者中常见的真菌。真菌感染的AECOPD患者临床表现无特异性。真菌分离阳性的AECOPD患者接受过支气管镜检查并使用抗生素的时间较长,更容易发生真菌感染。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Chinese medical journal pulmonary and critical care medicine
Chinese medical journal pulmonary and critical care medicine Critical Care and Intensive Care Medicine, Infectious Diseases, Pulmonary and Respiratory Medicine
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