Máiz Luis, Vendrell Montserrat, Olveira Casilda, Girón Rosa, Nieto Rosa, Martínez-García Miguel Ángel
Pneumology Service, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Respiration. 2015;89(5):396-403. doi: 10.1159/000381289. Epub 2015 Apr 23.
Information on the role of fungi in non-cystic fibrosis (CF) bronchiectasis is lacking.
Our aim was to determine the prevalence of and factors associated with the isolation and persistence of fungi from sputum in these patients.
We performed a multicenter observational study comprising adult patients with non-CF bronchiectasis. Persistence of Aspergillus spp. and Candida albicans was defined as the presence of ≥2 positive sputum cultures taken at least 6 months apart within a period of 5 years.
A total of 252 patients (62.7% women with a mean ± SD age of 55.3 ± 16.7 years) were included in the study. All patients had at least 1 sputum sample cultured for fungi, with a mean ± SD of 7 ± 6 cultures per patient. Eighteen (8.7%) and 71 (34.5%) patients had persistent positive cultures for Aspergillus spp. and C. albicans, respectively. Patients with persistence of Aspergillus spp. and C. albicans were older and had more daily purulent sputum. In addition, patients with persistent C. albicans had worse postbronchodilator forced expiratory volume in the first second (FEV1), more frequent cystic bronchiectasis, and more hospital-treated exacerbations. They were also more frequently treated with long-term antibiotics. Multivariate analysis showed that daily purulent sputum (OR = 3.75, p = 0.045) and long-term antibiotics (OR = 2.37, p = 0.005) were independently associated with persistence of Aspergillus spp. and C. albicans, respectively.
Isolation and persistence of Aspergillus spp. and C. albicans are frequent in patients with non-CF bronchiectasis. Daily purulent sputum and chronic antibiotic treatment were associated with persistence of Aspergillus spp. and C. albicans, respectively.
关于真菌在非囊性纤维化（CF）支气管扩张症中的作用，目前尚缺乏相关信息。
我们的目的是确定这些患者痰液中真菌分离及持续存在的患病率和相关因素。
我们开展了一项多中心观察性研究，纳入了患有非CF支气管扩张症的成年患者。曲霉属和白色念珠菌的持续存在定义为在5年内至少间隔6个月采集到≥2次阳性痰培养结果。
共有252例患者（62.7%为女性，平均年龄±标准差为55.3±16.7岁）纳入研究。所有患者至少有1份痰样本进行了真菌培养，每位患者平均培养次数±标准差为7±6次。分别有18例（8.7%）和71例（34.5%）患者曲霉属和白色念珠菌培养持续阳性。曲霉属和白色念珠菌持续存在的患者年龄更大，每日脓性痰更多。此外，白色念珠菌持续存在的患者支气管扩张剂使用后第1秒用力呼气量（FEV1）更差，囊性支气管扩张更频繁，因病情加重住院治疗的次数更多。他们接受长期抗生素治疗的频率也更高。多因素分析显示，每日脓性痰（比值比[OR]=3.75，p=0.045）和长期抗生素治疗（OR=2.37，p=0.005）分别与曲霉属和白色念珠菌的持续存在独立相关。
非CF支气管扩张症患者中曲霉属和白色念珠菌的分离及持续存在较为常见。每日脓性痰和长期抗生素治疗分别与曲霉属和白色念珠菌的持续存在相关。
