title: Clinical features of invasive pulmonary aspergillosis vs. colonization in COPD patients distributed by gold stage.
abstract: OBJECTIVE
  To explore clinical features of invasive pulmonary aspergillosis (IPA) vs. colonization among hospitalized COPD patients.
  
  
  METHODS
  Records of COPD patients with two respiratory cultures yielding Aspergillus were retrospectively reviewed. Cases categorized as proven/probable IPA or colonization was analyzed.
  
  
  RESULTS
  118 patients were identified: 70 (59.3%) colonized, 48 (40.7%) with IPA (42 probable, 6 proven). Higher percentage of IPA patients (vs. colonized) presented GOLD III + IV (77.1% vs. 57.1%, p = 0.025). IPA patients presented higher Charlson index (3.5 ± 2.5 vs. 2.6 ± 2.2, p = 0.027), higher rate of ICU admission (27.1% vs. 4.3%, p = 0.001) and worse prognosis (McCabe rapidly fatal category: 31.3% vs. 7.1%, p = 0.001). GOLD-I IPA patients presented risk factors other than COPD. Before hospitalization, 66.7% IPA and 28.6% colonized patients were taking steroids (p < 0.001). Antifungals were administered to 83.3% IPA and 21.4% colonized patients (p < 0.001). Mortality was higher among IPA vs. colonized patients, both in global (58.3% vs. 10.0%, p < 0.001), GOLD-I (75.0% vs. 10.0%, p = 0.041), GOLD-II (42.9% vs. 5.0%, p = 0.042) and GOLD-III patients (54.2% vs. 0.0%, p < 0.001), but not in GOLD-IV patients (69.2% vs. 31.3%, p = 0.066).
  
  
  CONCLUSIONS
  IPA should be suspected not only in GOLD-III and GOLD-IV COPD patients, with higher mortality in IPA vs. colonized patients for GOLD-II and -III COPD patients.
authors.affiliation: Infectious Diseases Dpt., Hospital Central de la Defensa Gomez Ulla, Gta. del Ejército s/n, 28047 Madrid, Spain. josebarberan@teleline.es
authors.forename: Jose
authors.initials: J
authors.lastname: Barberan
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanz
authors.forename: Jose-Luis
authors.initials: JL
authors.lastname: Hernandez
authors.forename: Silvia
authors.initials: S
authors.lastname: Merlos
authors.forename: Eduardo
authors.initials: E
authors.lastname: Malmierca
authors.forename: Francisco-Javier
authors.initials: FJ
authors.lastname: Garcia-Perez
authors.forename: Eloy
authors.initials: E
authors.lastname: Sanchez-Haya
authors.forename: Mar
authors.initials: M
authors.lastname: Segarra
authors.forename: Francisco
authors.initials: F
authors.lastname: Garcia de la Llana
authors.forename: Juan-Jose
authors.initials: JJ
authors.lastname: Granizo
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Gimenez
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D001234:Aspergillus niger / Q000302:isolation & purification; D002170:Canada / Q000453:epidemiology; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000382:microbiology; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents