Abstract
BackgroundIsolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. This study explored factors associated with diagnosis (infection vs. colonisation), treatment (administration or not of antifungals) and prognosis (mortality) in non-transplant/non-neutropenic patients showing repeated isolation of Aspergillus from lower respiratory samples.MethodsRecords of adult patients (29 Spanish hospitals) presenting ≥2 respiratory cultures yielding Aspergillus were retrospectively reviewed and categorised as proven (histopathological confirmation) or probable aspergillosis (new respiratory signs/symptoms with suggestive chest imaging) or colonisation (symptoms not attributable to Aspergillus without dyspnoea exacerbation, bronchospasm or new infiltrates). Logistic regression models (step–wise) were performed using Aspergillosis (probable + proven), antifungal treatment and mortality as dependent variables. Significant (p < 0.001) models showing the highest R2 were considered.ResultsA total of 245 patients were identified, 139 (56.7%) with Aspergillosis. Aspergillosis was associated (R2 = 0.291) with ICU admission (OR = 2.82), congestive heart failure (OR = 2.39) and steroids pre-admission (OR = 2.19) as well as with cavitations in X-ray/CT scan (OR = 10.68), radiological worsening (OR = 5.22) and COPD exacerbations/need for O2 interaction (OR = 3.52). Antifungals were administered to 79.1% patients with Aspergillosis (100% proven, 76.8% probable) and 29.2% colonised, with 69.5% patients receiving voriconazole alone or in combination. In colonised patients, administration of antifungals was associated with ICU admission at hospitalisation (OR = 12.38). In Aspergillosis patients its administration was positively associated (R2 = 0.312) with bronchospasm (OR = 9.21) and days in ICU (OR = 1.82) and negatively with Gold III + IV (OR = 0.26), stroke (OR = 0.024) and quinolone treatment (OR = 0.29). Mortality was 78.6% in proven, 41.6% in probable and 12.3% in colonised patients, and was positively associated in Aspergillosis patients (R2 = 0.290) with radiological worsening (OR = 3.04), APACHE-II (OR = 1.09) and number of antibiotics for treatment (OR = 1.51) and negatively with species other than A. fumigatus (OR = 0.14) and aspergillar tracheobronchitis (OR = 0.27).ConclusionsAdministration of antifungals was not always closely linked to the diagnostic categorisation (colonisation vs. Aspergillosis), being negatively associated with severe COPD (GOLD III + IV) and concomitant treatment with quinolones in patients with Aspergillosis, probably due to the similarity of signs/symptoms between this entity and pulmonary bacterial infections.
Highlights
Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance
Invasive aspergillosis is increasingly being recognised as an emerging opportunistic infection in non-neutropenic patients, with reports on patients receiving immunossupressive therapy that do not impair neutrophils count, patients with cancer, connective diseases requiring corticosteroids, liver cirrhosis, elderly patients, patients with less immunodeficiency such as patients with chronic obstructive pulmonary disease (COPD), specially those under steroid therapy, and Intensive Care Unit (ICU) patients without apparent predisposing immunodeficiency [7,8,9,10,11,12]
Since culture has poor specificity, it has been suggested the need for repeated isolation of the same Aspergillus species as part of the diagnosis of invasive aspergillosis [13], in a field where the use of diagnostic tools widely differs between different hospitals
Summary
Isolation of Aspergillus from lower respiratory samples is associated with colonisation in high percentage of cases, making it of unclear significance. Invasive disease has been described as disease of immunocompromised patients, and for high risk patients (those with bone marrow or solid organ transplant, neutropenia or haematological cancer [3]) standard definitions of opportunistic infection (proven, probable or possible) to express disease certainty have been internationally agreed [4]. In these type of patients, isolation of Aspergillus from lower respiratory tract samples is potentially significant [5], and acquires relevance since early diagnosis seems crucial to improve prognosis of this potentially treatable disease [1,6]. Since culture has poor specificity, it has been suggested the need for repeated isolation of the same Aspergillus species as part of the diagnosis of invasive aspergillosis [13], in a field where the use of diagnostic tools widely differs between different hospitals
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
