Clinical Features and Co-Infections in Invasive Pulmonary Aspergillosis in Elderly Patients

Abstract

Introduction

Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection. Old age is one of the important risk factors of IPA. However, data regarding the clinical characteristics and prognostic factors of elderly patients with IPA are limited, with data regarding co-infection of other bacteria or fungi even scarcer.

Methods

We performed a retrospective study of elderly patients (aged≥60) with IPA diagnosed in the First Affiliated Hospital of Sun Yat-sen University from January 2000 to December 2019. Data collection included demographic characteristics, premorbid conditions, underlying diseases, clinical manifestations, therapeutic procedures, and pathogenic detection. Associated factors were analyzed by logistic regression analysis.

Results

A total of 97 elderly patients (75 males, 22 females) with IPA were included. The all-cause mortality rate was 36.1% (35/97). Body mass index (BMI) (adjusted odds ratio (OR) 1.27, 95% confidence interval (CI) 1.08–1.50, P=0.01), solid organ malignancy (adjusted OR 5.37, 95% CI 1.35–21.33, P=0.02), and co-infections (adjusted OR 5.73, 95% CI 1.40–23.51, P=0.02) were associated with mortality in the elderly patients with IPA. Nearly, 76.3% (74/97) of the patients developed co-infections. Most of the infections (55/74, 74.3%) involved the lung. A total of 77 strains of bacteria were isolated, and Gram-negative bacteria (63/77, 81.3%) were predominant. Patients with co-infections are older (72.3±7.6 vs 67.4±7.4, P=0.04), prone to admit to the intensive care unit (ICU) (59.5% vs 26.1%, P=0.01), and present lymphopenia (60.8% vs 26.1%, P=0.004). In multivariate analysis, ICU admission (adjusted OR 4.57, 95% CI 1.53–13.67, P=0.01), and lymphopenia (adjusted OR 4.82, 95% CI 1.62–14.38, P=0.01) were significantly associated with co-infection in the elderly patients with IPA.

Conclusion

IPA is a fatal disease in the elderly population. Co-infection is closely associated with mortality. Lymphopenia could be an indicator for co-infection in the elderly patients with IPA.

Keywords:

• pulmonary aspergillosis
• elderly
• co-infection
• mortality

Abbreviations

BALF, bronchoalveolar lavage fluid; BMI, body mass index; CI, confidential interval; CKD, chronic kidney disease; CNS, coagulase negative staphylococci; COPD, chronic obstructive pulmonary disease; CTD, connective tissue disease; DM, diabetes mellitus; GC, glucocorticoid; GM, galactomannan; HSCT, high-resolution computed tomography; ICD-10, International Classification of Diseases; ICU, intensive care unit; IFD, invasive fungal disease; IPA, invasive pulmonary aspergillosis; IQR, interquartile range; MDR, multidrug resistance; MRSA, methicillin-resistant Staphylococcus aureus; OR, odds ratio; PDR, pandrug resistance; SD, standard deviation.

Data Sharing Statement

The datasets generated and analyzed in the current study are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

Ethics committee of the First Affiliated Hospital of Sun Yat-sen University approved the research (Approval number: 2,019,422), waiving written informed consent for deidentified patient data.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work. M. Lao, K. Zhang and M. Zhang contributed equally to this work.

Disclosure

The authors report no conflicts of interest for this work.