Abstract
With the widespread use of antibacterial drugs and increasing number of immunocompromised patients, pulmonary fungal infections are becoming more common. However, the incidence of pulmonary fungal and bacterial co-infection is rarely reported. In this study, 119 patients definitively diagnosed with pulmonary fungal infections between July 2018 and March 2020 were assessed using metagenomic next-generation sequencing (mNGS) as well as traditional pathogen detection to gauge the incidence of fungal and bacterial co-infection and evaluate the associated risk factors. We found that of the 119 patients with fungal infections, 48 (40.3%) had pulmonary fungal and bacterial co-infection. We identified immunocompromised status and the presence of one or more pulmonary cavities as risk factors associated with fungal and bacterial co-infection. The most commonly isolated fungi species were Aspergillus, Pneumocystis, and Rhizopus. The most commonly isolated bacterial species were Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. Seventy-nine (66.4%) patients had received empirical antibiotic treatment before their pathogenic test results became available, and 41.7% (fungal infection group) and 38.7% (fungal and bacterial co-infection group) of the patients had their antibacterial drug dosage changed accordingly. This mNGS-based study showed that the incidence of fungal and bacterial co-infection is significant. Our research outcomes can, thus, guide the use of antibacterial drugs in the treatment of clinical fungal infections.
Highlights
The human respiratory tract is exposed to various microorganisms present in the ambient atmosphere including fungi
The average age for the patients in the fungal and bacterial coinfection group and the fungal infection group was comparable at 43.04 years and 40.77 years, respectively
Current evidence on the incidence of pulmonary fungal infections accompanied by other pathogenic infections is sparse, with most studies focusing on the relationship between Aspergillus and Pseudomonas aeruginosa infection (Briard et al, 2015; Briard et al, 2016)
Summary
The human respiratory tract is exposed to various microorganisms present in the ambient atmosphere including fungi. Immune function can prevent fungal growth and invasion, but a growing number of immunocompromised patients and the widespread use of antibiotics has led to an increase in the incidence of pulmonary fungal infections (Limper et al, 2011; Denning and Chakrabarti, 2017; Li et al, 2021). One report provided evidence that the incidence of fungal. Fungal and Bacterial Co-Infection infections in hospitalized patients aged 14–30 years has shown a clear upward trend from 2013 to 2019 (Li et al, 2021). Invasive fungal infections are associated with high mortality, with mortality rates as high as 67% being reported among patients with acute infections (Chen et al, 2001). Pulmonary fungal infections represent a significant clinical and financial burden to the medical community
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