Pathogenic Distribution And Risk Factor Analysis Of COPD Patients With Secondary Pulmonary Fungal Infections

Objective: To understand the distribution of fungal species and their risk factors in COPD patients with secondary pulmonary fungal infections,Provide new clinical data for the prevention of pulmonary fungal infections in COPD patients.Methods: 63 COPD patients with pulmonary secondary fungal infections admitted to affiliated hospital of southwestern Medical University between December 2018 and December 2021 were selected as the observation group,and the distribution of their pathogenic fungi was counted.Another 63 COPD patients admitted to the hospital during the same period without secondary pulmonary fungal infections were randomly selected in a 1:1 ratio as the control group for a case-control study.The general data of the two groups were counted,and the risk factors for COPD patients with secondary pulmonary fungal infections were analyzed by single-factor and multi-factor logistic regression,and the predictive value of each risk factor was evaluated by ROC curve.Results: A total of 63 fungal strains were isolated from the observation group,in which Candida albicans(68.25%)was predominant,followed by Aspergillus fumigatus(12.70%),Candida tropicalis(9.52%),Candida smooth(6.35%),and Candida klebsiella(3.17%);as confirmed by the multifactorial logistic regression analysis,the presence of comorbidities(including type II respiratory failure,diabetes,hypoproteinemia,and secondary tuberculosis),antibiotic use for ≥ 14 days,combined antibiotic use,and intravenous glucocorticoid use were all independent risk factors for COPD patients with secondary pulmonary fungal infections(OR>1,P<0.05);ROC plots showed that the presence of type II respiratory failure,diabetes,hypoproteinemia,secondary tuberculosis comorbidity,antibiotic use for ≥14days,combined antibiotics,and intravenous glucocorticoids all had some predictive value for COPD patients with secondary pulmonary fungal infections,with the presence of antibiotics for ≥ 14 days,combined antibiotics,and hypoproteinemia having better predictive value for secondary pulmonary fungal infections in COPD patients with secondary pulmonary fungal infections,and the presence of each risk factor at the same time had the highest predictive value.Conclusion: The main causative agent of fungal infections in the lungs secondary in COPD patients is Candida albicans,followed by Candida fumigatus tropicalis,Candida smooth,and Candida klebsiella.the presence of type II respiratory failure,diabetes,hypoproteinemia,secondary tuberculosis comorbidity,antibiotic use for ≥ 14 days,combined antibiotics,and intravenous glucocorticoids are independent risk factors for COPD patients with secondary pulmonary fungal infections.Among them,antibiotic use for≥14 days,combined antibiotics,and hypoproteinemia had a better predictive value for secondary pulmonary fungal infections in COPD patients,and the predictive value of each risk factor was evaluated by ROC curve.