Incidence and etiology of chronic pulmonary infections in patients with idiopathic pulmonary fibrosis.

BACKGROUND:The incidence and etiologies of chronic pulmonary infection (CPI) in patients with idiopathic pulmonary fibrosis (IPF) have been poorly investigated. METHODS:We conducted a retrospective study of 659 patients with IPF to assess the incidence, etiologies, and risk factors of CPI development. CPI was defined if the etiology of infection was diagnosed one or more months after the onset of symptoms or upon the appearance of new shadows on pulmonary radiological images. RESULTS:At IPF diagnosis, 36 (5.5%) patients had CPI, and 46 (7.0%) patients without CPI at IPF diagnosis developed CPI over a median follow-up period of 6.1 years. The incidence density of CPI development was 18.90 cases per 1000 person-years. Detected organisms from these 46 patients were Mycobacterium avium complex in 20 patients, other nontuberculous mycobacteria in 4, M. tuberculosis in 7, Aspergillus spp. in 22, and Nocardia sp. in one. In a multivariate Cox regression hazard model, PaO2 <70 Torr and KL-6 ≥2000 U/mL were associated with CPI development. CONCLUSIONS:Nontuberculous mycobacteria, M. tuberculosis, and Aspergillus and Nocardia spp. were the four most frequent etiologies of CPI in patients with IPF. During follow-up of IPF, clinicians should pay attention to the development of CPI, especially in patients with PaO2 <70 Torr or KL-6 ≥2000 U/mL

Incidence and etiology of chronic pulmonary infections in patients with idiopathic pulmonary fibrosis v1

BackgroundThe incidence and etiologies of chronic pulmonary infection (CPI) in patients with idiopathic pulmonary fibrosis (IPF) have been poorly investigated. Methods We conducted a retrospective study of 659 patients with IPF to assess the incidence, etiologies, and risk factors of CPI development. CPI was defined if the etiology of infection was diagnosed one or more months after the onset of symptoms or upon the appearance of new shadows on pulmonary radiological images. Results At IPF diagnosis, 36 (5.5%) patients had CPI, and 46 (7.0%) patients without CPI at IPF diagnosis developed CPI over a median follow-up period of 6.1 years. The incidence density of CPI development was 18.90 cases per 1000 person-years. Detected organisms from these 46 patients were Mycobacterium avium complex in 20 patients, othernontuberculous mycobacteria in 4, M. tuberculosis in 7, Aspergillus spp. in 22, and Nocardia sp. in one. In a multivariate Cox regression hazard model, PaO2 &lt;70 Torr and KL-6 ≥2000 U/mL were associated with CPI development. Conclusions Nontuberculous mycobacteria, M. tuberculosis, and Aspergillusand Nocardia spp. were the four most frequent etiologies of CPI in patients with IPF. During follow-up of IPF, clinicians should pay attention to the development of CPI, especially in patients with PaO2 &lt;70 Torr or KL-6 ≥2000 U/mL. </p

Causes of death in patients with idiopathic pulmonary fibrosis (IPF) with or without chronic pulmonary infections.

Causes of death in patients with idiopathic pulmonary fibrosis (IPF) with or without chronic pulmonary infections.</p

Kaplan-Meier survival curves according to the presence or absence of CPI (Group A versus B).

A log-rank test showed that the difference was not significant (p = 0.416).</p

Kaplan-Meier curves for the time until the development of CPI (Groups A and B).

CPA = chronic pulmonary aspergillosis; MAC = Mycobacterium avium complex pulmonary disease; NTM = nontuberculous mycobacteriosis; TB = tuberculosis.</p

Univariate and multivariate analysis of the risk of chronic pulmonary infections (Groups A, B).

Univariate and multivariate analysis of the risk of chronic pulmonary infections (Groups A, B).</p

Diagram of the patients with or without CPI at IPF diagnosis or the follow-up period.

MPA = microscopic polyangiitis.</p

Baseline characteristics of the study patients with IPF according to presence or absence of chronic pulmonary infections at diagnosis or during follow-up.

Baseline characteristics of the study patients with IPF according to presence or absence of chronic pulmonary infections at diagnosis or during follow-up.</p