title: Significance of lower respiratory tract cultures yielding Aspergillus spp. growth in a hospital without transplant patients.
abstract: BACKGROUND
  Isolation of Aspergillus spp. in non-neutropenic, non-transplant patients with chronic obstructive pulmonary disease (COPD) usually treated with corticosteroids is not easily interpretable. A retrospective review of clinical records corresponding to cultures (respiratory samples) yielding Aspergillus spp. in non- transplant patients was carried out.
  
  
  METHODS
  Patients were assigned to four categories: colonization, possible, probable or definitive aspergillosis. A logistic regression model (step-wise procedure) was performed using as dependent variable mortality, and as independent variables those showing differences (p≤0.1) in the bivariant analysis.
  
  
  RESULTS
  Sixty-nine patients were identified. Most were elderly (68.1% ≥65 years), male (73.9%), presented comorbidities (84.1% Charlson index ≥3), COPD (76.8%), were receiving high corticosteroid doses (66.7%), and had previously received antibiotics (94.2%). Forty-five cases were colonizations, 4 possible, 15 probable and 5 definitive aspergillosis. A. fumigatus was isolated in 75.4% patients: 66.7% colonized, 75% possible, 93.3% probable and 100% definitive aspergillosis. Colonized patients were older (71.9 ± 11.9 vs. 65.1 ± 9.2 years; p= 0.018) and presented higher (p=0.034) comorbidity index than patients with aspergillosis. Mortality was 31.1% in colonized vs. 62.5% in aspergillosis (p=0.012).
  
  
  CONCLUSIONS
  The isolation of A. fumigatus was associated with an increased probability of aspergillosis, with statistical association in the multivariate analysis between mortality and variables related to chemotherapy (no antifungal treatment), disease (diagnostic category) and immunity (leukocytosis).
authors.affiliation: Infectious Diseases Dpt, Hospital Central de la Defensa, 28047 Madrid, Spain. palolucenac@yahoo.es
authors.forename: Paloma
authors.initials: P
authors.lastname: Lucena
authors.forename: José
authors.initials: J
authors.lastname: Barberán
authors.forename: Guillermo
authors.initials: G
authors.lastname: Eroles
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.forename: María-José
authors.initials: MJ
authors.lastname: Giménez
authors.forename: Nuria
authors.initials: N
authors.lastname: Mir
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
authors.forename: José
authors.initials: J
authors.lastname: Prieto
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Cuétara
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000382:microbiology; D001230:Aspergillus / Q000472:pathogenicity*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000382:microbiology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000150:complications / Q000382:microbiology*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents