Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by gold stage.

J Infect. 2012 Aug 3. [Epub ahead of print]

Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by gold stage.

Source

Infectious Diseases Dpt., Hospital Central de la Defensa Gomez Ulla, Gta. del Ejército s/n, 28047 Madrid, Spain.

Abstract

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 API or colonization was analyzed.

RESULTS:

118 patients were identified: 70 (59.3%) colonized, 48 (40.7%) with API (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 ± 2.5 vs. 2.6 ± 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.

Copyright © 2012. Published by Elsevier Ltd.

PMID:

 22863904

[PubMed – as supplied by publisher]

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