Multivariate Analysis Of Culture Of Aspergillus Sputum In Chronic Obstructive Pulmonary Disease

Objective To investigate the risk factors and clinical outcome associated with invasive pulmonary Aspergillosis in patients with AECOPD in whom Aspergillus spp.were isolated from respiratory secretions.Methods Fifty-two patients with COPD in whom Aspergillus spp.were isolated from respiratory secretions at the First Affiliated Hospital of Qingdao University from January 2014 to January 2015,were analyzed retrospectively according to the diagnostic criteria of IPA.Collect all of the patient's clinical data,including age,gender,disease(diabetes,renal insufficiency,cardiac insufficiency),glucocorticoid use,use of broad-spectrum antibiotics,mechanical ventilation,serum albumin level,previous fungal infection or colonization history,times of hospitalization in the past 1 years,anti fungal treatment and prognosis.In this study,the long-term use of glucocorticoids was defined as systemic application,equivalent to prednisone dose of 30 mg/d,continuous application of more than 10 d or <30 mg/d continuous application for more than 1 months.Results Fifty-two cases were classified as proven IPA(n=7),probable(n=18)and colonization(n=27).According to univariate analysis,the risk factors associated with IPA included long-term glucocorticosteriod use,prolonged administration of broad-spectrum antibiotics,mechanical ventilation and the increasing number of hospital admissions in the past year.But by multivariable logistic regression analysis,long-term glucocorticosteriod use and the increasing number of hospital admissions within the past year were the independent factors significantly associated with IPA.Patients with IPA had high mortality than colonized patients(84% vs.22.2%,P<0.001).Multivariable analysis showed that delayed diagnosis and treatment were associated with poor outcome of IPA.Conclusions Prolonged corticosteroids treatment and the increasing number of hospital admissions within the past year are the major predisposing factors for IPA in patients with COPD in whom Aspergillus spp.were isolated from respiratory secretions.