Risk factors for pulmonary Aspergillus terreus infection in patients with positive culture for filamentous fungi.
BACKGROUND
Invasive aspergillosis (IA) is a common fungal infection in immunocompromised patients and has a high mortality rate. Among patients with IA, Aspergillus terreus infections have become a growing concern in the past few years.


OBJECTIVE
To determine the clinical risk factors for isolation of and respiratory infection by A terreus in 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 terreus was present in 46 isolates from 40 patients (9.1%). Clinical histories were reviewed to identify the risk factors related to isolation of and infection by A 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 for A terreus were 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 invasive A terreus infection 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 of A terreus infection (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 of A terreus infections. In these patients, transplantation is associated with a lower risk of isolation and respiratory infection by A terreus.
Castón
Juan José
JJ
Unit of Infectious Diseases, Reina Sofía University Hospital, Córdoba, Spain.
Linares
María José
MJ
Gallego
Carolina
C
Rivero
Antonio
A
Font
Pilar
P
Solís
Francisco
F
Casal
Manuel
M
Torre-Cisneros
Julián
J
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000175:diagnosis* / Q000382:microbiology* / Q000517:prevention & control; D001230:Aspergillus / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors
D000336:Aerosols; D000935:Antifungal Agents; D000666:Amphotericin B