Clinical characteristics of patients with positive fungal pathogens during acute exacerbation of chronic obstructive pulmonary disease: A retrospective study

Abstract

Background: Fungal infections in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients are poorly understood and often result in a poor prognosis. This study aimed to investigate the distribution of common fungi and the clinical features of AECOPD patients positive for fungal pathogens.

Methods: Data were collected from inpatients with AECOPD at the Second Xiangya Hospital of Central South University from January 2016 to December 2019. The enrolled patients were divided into an infection group and a colonization group, and clinical data were compared between the two groups. A 1:1 propensity score matching (PSM) process was employed to ensure balanced samples to analyze the impact of positive fungal pathogens on the clinical features of AECOPD patients. The incidence of acute exacerbations one year after discharge was determined via telephone follow-up.

Results: The most frequently isolated fungal pathogen was Candida albicans (164/395, 41.5 %), followed by Aspergillus (93/395, 23.5 %). After propensity score matching, 68 patients were equally divided into the infection and colonization groups. There was no significant difference in clinical manifestations between the infection and colonization groups (P > 0.05). Patients in the infection group had significantly higher procalcitonin (PCT) values (0.2 [0.1, 0.7] ng/ml vs. 0.1 [0, 0.1] ng/ml; P = 0.003) and lower albumin/globulin ratios (1.1 [0.6, 1.3] vs. 1.1 [1.0, 1.3], P = 0.047) than those in the colonization group. The antibiotic treatment (12.5 [11.0, 19.0] days vs. 10.0 [8.0, 14.0] days; P = 0.002) and hospitalisation duration (18.0 [14.7, 22.5] days vs. 11.0 [8.0, 16.0] days; P < 0.001) in the infection group was significantly longer than that in the colonization group. In addition, more patients in the colonization group received non-invasive mechanical ventilation (76.5 % [26/34] vs. 47.1 % [16/34]; P = 0.013). Compared with the colonization group, more patients in the infection group underwent bronchoscopy (29.4 % [10/34] vs. 2.9 % [1/34]; P = 0.003). Using multivariable analysis, we found that bronchoscopy (OR: 1.350, 95 % CI: 1.020-1.771, P = 0.034) and duration of antibiotics used (OR: 1.318, 95 % CI: 1.090-1.560, P = 0.004) were risk factors for pulmonary fungal infection in AECOPD patients.

Conclusion: Candida albicans and Aspergillus are the common fungi isolated from patients with AECOPD. The clinical manifestations of AECOPD patients with fungal infection are nonspecific. AECOPD patients with positive fungal isolation who have undergone bronchoscopy and used antibiotics for a longer duration are more likely to have fungal infection.

Keywords: Chronic obstructive pulmonary disease; Colonization; Fungal pathogen; Infection; Risk factor.

Fig. 1

Flow chart of the enrollment of patients with positive fungal pathogens during acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Fig. 2

Chest CT imaging in AECOPD patients with positive fungal pathogens. (A–B) CT plain scan showed multiple patchy areas of increased density in both lungs. Arrow indicates patchy areas of increased density; (C) CT plain scan showed a nodular high-density shadow in the right lower lung. Arrow indicates nodular high-density shadow in the right lower lung; (D) CT plain scan showed a nodular high-density shadow in the left lower lung. Arrow indicates nodular high-density shadow in the left lower lung; (E–F) CT plain scan showed bilateral pleural effusion. Arrow indicates pleural effusion.