Risk Factors of Invasive Pulmonary Aspergillosis in Patients with Interstitial Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 ZhuangYi , DaiJinghong , ZhangYingwei , CaoMengshu , LiuYin , LiHui , YanXin , XiaoYonglong , CaiHourong

Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, 210008, China;

Corresponding author：

ZhuangYi, Email: drzy78@163.com

Keywords：

Interstitial pneumonia; Invasive pulmonary aspergillosis; Risk factors

DOI：

10.7507/1671-6205.2016104

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Objective To analyze the risk factors of invasive pulmonary aspergillosis (IPA) in patients with interstitial pneumonia. Methods The clinical data of 770 cases of interstitial pneumonia admitted between December 2010 and August 2015 were collected. Among them, 46 cases were combined with IPA and 724 cases were not ombined with IPA. The clinical data was analyzed to explore the risk factors of IPA in patients with interstitial pneumonia. Results Univariate analysis showed that in the aspects of age (t=3.348, P=0.001), serum albumin level (t=8.381, P < 001), broad-spectrum antibiotic used within 3 months (χ²=87.157, P < 001), long-term administration of glucocorticoid (χ²=57.462, P < 001), long-term administration of immunosuppressive agents (χ²=31.715, P < 001), imaging in UIP type (χ²=20.632, P < 001), diabetes mellitus (χ²=9.737, P=0.002) and heart failure (χ²=9.300, P=0.002), there were significant differences between two groups. After multivariate logistic regression analysis, broad-spectrum antibiotic used within 3 months (OR=4.773, P < 001), long-term administration of glucocorticoid (OR=9.195, P < 001), long-term administration of immunosuppressive agents (OR=2.662, P=0.046), imaging in UIP type (OR=5.725, P < 001), and diabetes mellitus (OR=3.847, P=0.003) were found to be the risk factors of IPA in patients with interstitial pneumonia. Serum albumin level was negatively correlated with the occurrence of IPA in patients with interstitial pneumonia. Conclusions Various factors contribute to the occurrence of IPA in patients with interstitial pneumonia. Miscellaneous appropriate measures should be taken to reduce the incidence of IPA.

Citation： Zhuang Yi, Dai Jinghong, Zhang Yingwei, Cao Mengshu, Liu Yin, Li Hui, Yan Xin, Xiao Yonglong, Cai Hourong. Risk Factors of Invasive Pulmonary Aspergillosis in Patients with Interstitial Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(5): 442-445. doi: 10.7507/1671-6205.2016104 Copy

1.	Kurosaki F, Bando M, Nakayama M, et al. Clinical features of pulmonary aspergillosis associated with interstitial pneumonia. Intern Med, 2014, 53:1299-1306.
2.	American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med, 2002, 165:277-304.
3.	Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America. Clinical infectious diseases:an official publication of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46:327-360.
4.	中华医学会呼吸病学分会感染学组, 中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识.中华结核和呼吸杂志, 2007, 30:821-834.
5.	Steinbach WJ, Marr KA, Anaissie EJ, et al. Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect, 2012, 65:453-464.
6.	Menzin J, Meyers JL, Friedman M, et al. Mortality, length of hospitalization, and costs associated with invasive fungal infections in high-risk patients. Am J Health Syst Pharm, 2009, 66:1711-1717.
7.	Cadena J, Thompson GR 3rd, Patterson TF. Invasive Aspergillosis:current strategies for diagnosis and management. Infect Dis Clin North Am, 2016, 30:125-142.
8.	Caston JJ, Linares MJ, Rivero A, et al. Clinical factors associated with invasive pulmonary aspergillosis in patients with chronic pneumopathies and respiratory isolation of Aspergillus spp. Med Clin, 2012, 139:668-671.
9.	Mosquera RA, Estrada L, Clements RM, et al. Early diagnosis and treatment of invasive pulmonary aspergillosis in a patient with cystic fibrosis. BMJ Case Rep, 2013, 2013.
10.	Wessolossky M, Welch VL, Sen A, et al. Invasive Aspergillus infections in hospitalized patients with chronic lung disease. Infect Drug Resist, 2013, 6:33-39.
11.	Hagiya H, Miyake T, Kokumai Y, et al. Co-infection with invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonia after corticosteroid therapy. J Infect Chemother, 2013, 19:342-347.
12.	Yang J, Lu Q, Liu W, et al. Cyclophosphamide reduces dectin-1 expression in the lungs of naive and Aspergillus fumigatus-infected mice. Med Mycol, 2010, 48:303-309.
13.	Kolwijck E, van de Veerdonk FL. The potential impact of the pulmonary microbiome on immunopathogenesis of Aspergillus-related lung disease. Eur J Immunol, 2014, 44:3156-3165.
14.	Mowat E, Rajendran R, Williams C, et al. Pseudomonas aeruginosa and their small diffusible extracellular molecules inhibit Aspergillus fumigatus biofilm formation. FEMS Microbiol Lett, 2010, 313:96-102.
15.	Seidler MJ, Salvenmoser S, Muller FM. Aspergillus fumigatus forms biofilms with reduced antifungal drug susceptibility on bronchial epithelial cells. Antimicrob Agents Chemother, 2008, 52:4130-4136.
16.	Seibold MA, Wise AL, Speer MC, et al. A common MUC5B promoter polymorphism and pulmonary fibrosis. New Engl J Med, 2011, 364:1503-1512.
17.	Hu R, Jiang XY, Wu Y. Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant. Neoplasma, 2012, 59:669-675.

1. Kurosaki F, Bando M, Nakayama M, et al. Clinical features of pulmonary aspergillosis associated with interstitial pneumonia. Intern Med, 2014, 53:1299-1306.
2. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med, 2002, 165:277-304.
3. Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis:clinical practice guidelines of the Infectious Diseases Society of America. Clinical infectious diseases:an official publication of the Infectious Diseases Society of America. Clin Infect Dis, 2008, 46:327-360.
4. 中华医学会呼吸病学分会感染学组, 中华结核和呼吸杂志编辑委员会.肺真菌病诊断和治疗专家共识.中华结核和呼吸杂志, 2007, 30:821-834.
5. Steinbach WJ, Marr KA, Anaissie EJ, et al. Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect, 2012, 65:453-464.
6. Menzin J, Meyers JL, Friedman M, et al. Mortality, length of hospitalization, and costs associated with invasive fungal infections in high-risk patients. Am J Health Syst Pharm, 2009, 66:1711-1717.
7. Cadena J, Thompson GR 3rd, Patterson TF. Invasive Aspergillosis:current strategies for diagnosis and management. Infect Dis Clin North Am, 2016, 30:125-142.
8. Caston JJ, Linares MJ, Rivero A, et al. Clinical factors associated with invasive pulmonary aspergillosis in patients with chronic pneumopathies and respiratory isolation of Aspergillus spp. Med Clin, 2012, 139:668-671.
9. Mosquera RA, Estrada L, Clements RM, et al. Early diagnosis and treatment of invasive pulmonary aspergillosis in a patient with cystic fibrosis. BMJ Case Rep, 2013, 2013.
10. Wessolossky M, Welch VL, Sen A, et al. Invasive Aspergillus infections in hospitalized patients with chronic lung disease. Infect Drug Resist, 2013, 6:33-39.
11. Hagiya H, Miyake T, Kokumai Y, et al. Co-infection with invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonia after corticosteroid therapy. J Infect Chemother, 2013, 19:342-347.
12. Yang J, Lu Q, Liu W, et al. Cyclophosphamide reduces dectin-1 expression in the lungs of naive and Aspergillus fumigatus-infected mice. Med Mycol, 2010, 48:303-309.
13. Kolwijck E, van de Veerdonk FL. The potential impact of the pulmonary microbiome on immunopathogenesis of Aspergillus-related lung disease. Eur J Immunol, 2014, 44:3156-3165.
14. Mowat E, Rajendran R, Williams C, et al. Pseudomonas aeruginosa and their small diffusible extracellular molecules inhibit Aspergillus fumigatus biofilm formation. FEMS Microbiol Lett, 2010, 313:96-102.
15. Seidler MJ, Salvenmoser S, Muller FM. Aspergillus fumigatus forms biofilms with reduced antifungal drug susceptibility on bronchial epithelial cells. Antimicrob Agents Chemother, 2008, 52:4130-4136.
16. Seibold MA, Wise AL, Speer MC, et al. A common MUC5B promoter polymorphism and pulmonary fibrosis. New Engl J Med, 2011, 364:1503-1512.
17. Hu R, Jiang XY, Wu Y. Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant. Neoplasma, 2012, 59:669-675.

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