Risk Factors for PulmonaryAspergillus terreusInfection in Patients With Positive Culture for Filamentous Fungi

Abstract

Background:Invasive aspergillosis (IA) is a common fungal infection in immunocompromised patients and has a high mortality rate. Among patients with IA,Aspergillus terreusinfections have become a growing concern in the past few years.Objective:To determine the clinical risk factors for isolation of and respiratory infection byA terreusin patients with culture findings positive for filamentous fungiMethods:Cohort study of 505 consecutive isolates of filamentous fungi in 332 patients from one center.A terreuswas present in 46 isolates from 40 patients (9.1%). Clinical histories were reviewed to identify the risk factors related to isolation of and infection byA terreus, which were grouped into three categories (ie, host factors, factors related to immunosuppression, and factors related to hospitalization), and were analyzed using a multiple logistic regression model.Results:A total of 192 of 505 isolates studied (38%) were due to invasive respiratory infection. A total of 27 of 46 cultures (58.7%) that were positive forA terreuswere due to invasive infection (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.37 to 4.69; p = 0.034). The factors associated with invasiveA terreusinfection were prophylactic use of amphotericin B aerosols (OR, 27.8; 95% CI, 6.7 to 109.7; p = 0.001) and mechanical ventilation (OR, 3.3; 95% CI, 1.02 to 10.9; p = 0.04). Transplantation was associated with a lower risk ofA terreusinfection (OR, 0.2; 95% CI, 0.046 to 0.789; p = 0.02).Conclusions:In patients with culture findings positive for filamentous fungi, the prophylactic use of amphotericin B aerosols and mechanical ventilation are associated with a higher risk ofA terreusinfections. In these patients, transplantation is associated with a lower risk of isolation and respiratory infection byA terreus.