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New insights into the clinical characteristics and prognostic factors of pulmonary fungal infections from a retrospective study in Southwestern China

Authors Peng L, Xu Z, Huo Z, Long R, Ma L

Received 14 November 2017

Accepted for publication 9 January 2018

Published 5 March 2018 Volume 2018:11 Pages 307—315

DOI https://doi.org/10.2147/IDR.S157030

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Eric Nulens

Li Peng,1 Zhiping Xu,2 Zhenyu Huo,1 Rui Long,3 Liang Ma4

1Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, 2Department of Respiratory Medicine, The Fifth People’s Hospital of Chongqing, 3Department of Pharmacy, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 4Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA

Background: Despite increasing incidence of pulmonary fungal infections (PFIs) worldwide, the clinical characteristics and prognostic factors remain poorly understood. The goal of this study was to investigate the clinical features, laboratory findings, and outcomes of hospitalized patients diagnosed with PFIs.
Methods: We retrospectively enrolled 123 patients at a university hospital in Southwestern China between February 2014 and May 2016, who were diagnosed with PFIs based on clinical presentations and laboratory tests including fungal culture and pathological examination. Medical records were reviewed and analyzed. Prognostic factor associated with mortality was evaluated by multivariate regression analysis.
Results: Of the 123 PFI patients enrolled, the mean age was 67 years with 72% of them being males. In addition to common clinical features reported previously, these patients exhibited distinct characteristics, with the elderly accounting for 79% of all cases, and with prolonged hospitalization being the most prevalent risk factor (74%) and chronic obstructive pulmonary disease (COPD) being the most common underlying disease (45%). Invasive operation was significantly more frequently involved in patients with unfavorable treatment responses than in patients with favorable responses (45.6 vs 7.4%, P=0.000). By multivariate regression analysis, invasive operation (odds ratio [OR]: 5.736, 95% confidence interval [CI]: 2.008–16.389, P=0.001) and hypoalbuminemia (OR: 3.936, 95% CI: 1.325–11.696, P=0.014) were independent prognostic factors of mortality in PFIs.
Conclusion: This study provides new insights into the clinical characteristics and prognostic factors of PFIs and highlights the necessity to be aware of PFIs in patients with COPD and patients receiving invasive operation in order to improve clinical management of these patients.

Keywords: pulmonary fungal infection, risk factors, prognostic factors, chronic obstructive pulmonary disease, invasive operation
 

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