Chest
Volume 131, Issue 1, January 2007, Pages 230-236
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Original Research: Respiratory Infection
Risk Factors for PulmonaryAspergillus terreusInfection in Patients With Positive Culture for Filamentous Fungi

https://doi.org/10.1378/chest.06-0767Get rights and content

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 fungi

Methods: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.

Section snippets

Study Population

A retrospective cohort study was performed involving 505 consecutive isolates of filamentous fungi in 332 patients who had been hospitalized or treated as outpatients in a single hospital between 1994 and 2004. The identified isolates were from the following respiratory samples: (1) sputum (considered valid when < 10 epithelial cells and > 25 polymorphonuclear cells were observed on a Gram stain); (2) BAL fluid; (3) bronchial aspirate; (4) fine-needle aspiration; and (5) lung biopsy specimen.

Description of Isolates and Population

A total of 505 cultures positive for filamentous fungi (Table 2), it was found that 127 of the 300 isolates ofA fumigatus(42.3%) corresponded to infection, without a statistical difference compared to episodes of colonization. However, 27 of the 46 isolates ofA terreus(58.7%) corresponded to invasive infection, and a significant difference was found compared to episodes of colonization (OR, 2.53; 95% CI, 1.37 to 4.69; p = 0.034).

Risk Factors for Positive Culture byA terreus

After the univariate analysis, multiple logistic regression

Discussion

In our study, 9.1% of the isolates of filamentous fungi observed over the 10-year period were due toA terreus. This fungus was the second most common cause of respiratory Aspergillus isolation, which contrasts with the findings reported in most previous studies.3, 10, 11In our series, the overall incidence of culture findings positive for filamentous fungi, includingA terreus, was 1.73 cases per 10,000 patients per year. This incidence was increased from 1998, coinciding with hospital

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    This work was supported in part by Fondo Investigaciones Sanitarias de la Seguridad Social (grant No. G03/075 RESITRA).

    The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).

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