Prevalence and Factors Associated with Isolation of <b><i>Aspergillus</i></b> and <b><i>Candida </i></b>from Sputum in Patients with Non-Cystic Fibrosis Bronchiectasis

Abstract

Background: Information on the role of fungi in non-cystic fibrosis (CF) bronchiectasis is lacking. Objectives: Our aim was to determine the prevalence of and factors associated with the isolation and persistence of fungi from sputum in these patients. Methods: 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. Results: 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. Conclusions: 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.

Research priorities in bronchiectasis: a consensus statement from the EMBARC Clinical Research Collaboration

“…Haemophilus influenzae and P. aeruginosa are the most commonly isolated organisms in several European studies using aerobic selective cultures, although no organisms are isolated in 23-27% of patients [9,17,36,37]. New methods to study lung microbiota have found that the diversity of airway infection is underestimated, with anaerobic bacteria found in up to 83% of sputum samples, and that three taxa, Streptococcaceae, Pseudomonadaceae and Pasturellaceae, seem to be dominant [38]. However, most microbiome studies in bronchiectasis to date have been small, and therefore the clinical importance of this information is uncertain.…”

“…However, most microbiome studies in bronchiectasis to date have been small, and therefore the clinical importance of this information is uncertain. Few data have been published regarding the prevalence of fungal colonisation and it is now possible to perform sequencing of the fungal "mycobiome" in a similar way to that described above for bacteria [38][39][40]. The prevalence of nontuberculous mycobacteria (NTM) in Europe is <10%, although there seems to be a broad geographic variation [41].…”

“…Since few options are currently available to intervene on microbial characteristics, most of the current efforts are dedicated to improving antibiotic characteristics and optimising their administration [43]. Regarding the use of long-term antibiotics, periodic administration of rotating or fixed antibiotics is potentially associated with increased resistance and side-effects, and risk of selection of fungal infection [38,44,45]. Although prolonged therapy with macrolides is effective in reducing exacerbations, there is a clear risk of antibiotic resistance for both sputum and oropharyngeal flora, and a more careful selection of patients undergoing this treatment is recommended [46][47][48][49].…”

FUT2genotype influences lung function, exacerbation frequency and airway microbiota in non-CF bronchiectasis

“…Respiratory viral9 and fungal10 infections have also been linked to bronchiectasis disease markers, which suggests that multiple infectious agents can contribute to the pathophysiology of non-cystic fibrosis bronchiectasis. While genetic loci in genes related to inflammation and airway remodelling have been previously investigated in non-cystic fibrosis bronchiectasis,11–15 little is known regarding common genetic polymorphisms that affect microbial acquisition in patients.…”

Microbiological Progress in Patients with Bronchial Infection with <b><i>Pseudomonas aeruginosa</i></b> Treated with Nebulised Colistin

“…are the fungi that are most usually isolated in the respiratory tract of patients with respiratory chronic diseases, such as bronchiectasis [31, 32]. Some authors have suggested that nebulised antibiotics could be a predisposing risk factor for fungal respiratory infections [11, 12].…”