Establishment of risk factor scoring system for invasive fungal infection in children with PICU
LI Qian1 DING Xiangyu1 JIA Lili2 ZHANG Guying1
1.Department of Pharmacy, Children’s Hospital of Hebei Province, Hebei Province, Shijiazhuang 050031, China;
2.Basic Medicine Department, Shijiazhuang Medical College, Hebei Province, Shijiazhuang 050000, China
Abstract：Objective To analyze the high risk factors of invasive fungal infection (IFI) in children with pediatric intensive care unit (PICU) and to establish a risk scoring system. Methods The clinical data of 65 hospitalized children with IFI diagnosis in PICU of Children’s Hospital of Hebei Province from January 2015 to June 2020 were analyzed and included in observation group; according to the principle of 1∶1 allocation, 65 cases of non-IFI hospitalized children with similar underlying diseases in the same period and ward were included in control group. The independent risk factors affecting the occurrence of IFI in children with PICU were analyzed and assigned, an IFI risk scoring system was established, and the ROC curve was drawn to verify the effectiveness of the scoring system. Results The length of hospitalization in observation group was longer than that of control group; and the proportion of indwelling gastric tube, indwelling urinary catheter, central venous catheter, mechanical ventilation >3 days, combination of two or more antibacterial drugs, hypoproteinemia, surgery of observation group were higher than those of control group, and the differences were statistically significant (P < 0.05). Hospitalization days (OR = 1.109, 95%CI: 1.048-1.174), central venous catheter (OR= 38.344, 95%CI: 5.354-274.609), combination of two or more antibacterial drugs (OR=6.194, 95%CI: 2.267-16.924) were independent risk factors for IFI in PICU children (P < 0.05). According to the regression coefficients of independent risk factors, the length of stay was 1, the central venous catheter was 36, and the combination of two or more antibacterial drugs was 18, and a scoring system was established. ROC curve showed that area under the curve was 0.875 (95%CI: 0.816-0.934, P < 0.001), the cut-off value was 0.615, corresponding to the critical value of 28, and the sensitivity was 0.754 and specificity was 0.862. Conclusion The scoring system has good excellent efficiency and good specificity, which is of certain significance for PICU in early identification of IFI high-risk children.
李倩1 丁翔宇1 贾丽丽2 张古英1. PICU患儿侵袭性真菌感染的高危因素评分系统建立[J]. 中国医药导报, 2021, 18(29): 94-97.
LI Qian1 DING Xiangyu1 JIA Lili2 ZHANG Guying1. Establishment of risk factor scoring system for invasive fungal infection in children with PICU. 中国医药导报, 2021, 18(29): 94-97.
[1] 郑天，李秋平，陈海花，等.新生儿侵袭性深部真菌感染的临床特点分析[J].发育医学电子杂志，2019，7（4）：292-296.
[2] Ishiwada N，Kitajima H，Morioka I，et al. Nationwide survey of neonatal invasive fungal infection in Japan [J]. Medical Mycology，2018，56（6）：679-686.
[3] 董方，周为，甄景慧，等.儿童侵袭性真菌感染的菌种分布和耐药性特征分析[J].中华实用儿科临床杂志，2020， 35（16）：1248-1251.
[4] 段思蒙，肖盟，黄晶晶，等.2012年度侵袭性真菌耐药监测网（CHIF-NET）侵袭性酵母菌感染的分布特征[J].中国真菌学杂志，2021，16（4）：234-242.
[5] 张得菊，韩晓萍，李建英，等.急诊ICU医院侵袭性肺部真菌感染影响因素分析[J].中华医院感染学杂志，2018， 28（17）：2583-2585.
[6] 张涛，武宇辉，杨卫国，等.儿童重症监护病房侵袭性真菌感染49例临床分析[J].中国小儿急救医学，2019，26（3）：201-205.
[7] Paiva JA，Pereira JM. Biomarkers of fungal lung infection [J]. Curr Opin Infect Dis，2019，32（2）：136-142.
[8] ?魻ncü B，Belet N，Emecen AN，et al. Health care-associated invasive Candida infections in children [J]. Med Mycol，2019，57（8）：929-936.
[9] Mantadakis E，Pana ZD，Zaoutis T. Candidemia in children：epidemiology，prevention and management [J]. Mycoses，2018，61（9）：614-622.
[10] Walsh TJ，Katragkou A，Chen T，et al. Invasive candidiasis in infants and children：recentadvances in epidemiology，diagnosis，and treatment [J]. J Fungi（Basel），2019，5（1）：11-19.
[11] de Araujo Motta F，Dalla-Costa LM，Dominguez Muro M，et al. Risk adjustment for congenital heart surgery score as a risk factor for candidemia in children undergoing congenital heart defect surgery [J]. Pediatr Infect Dis J，2016，35（11）：1194-1198.
[12] 中华医学会儿科学分会呼吸学组，《中华儿科杂志》编辑委员会.儿童侵袭性肺部真菌感染诊治指南（2009版）[J].中华儿科杂志，2009，47（2）：96-97.
[13] 辜淑君，林育能，吴上志，等.儿童肺部侵袭性真菌感染回顾性分析[J].国际呼吸杂志，2020，40（7）：531-535.
[14] 陈彩英，邓春，龚放.新生儿侵袭性真菌感染的危险因素及病原学分析[J].儿科药学杂志，2021，27（1）：24-27.
[15] 桂明珠.早产儿侵袭性真菌感染相关危险因素和临床诊治研究[J].世界临床药物，2019，40（9）：642-648.
[16] 孙海燕，刘飞宇，张雷，等.血液病患者侵袭性真菌感染危险评分系统的建立[J].中国药房，2018，29（9）：1270-1273.
[17] 刘波，王丽杰.儿科重症监护病房院内侵袭性真菌血流感染21例临床分析[J].中国实用儿科杂志，2019，34（6）：508-512.
[18] 吴玮哲，彭艳芬，王洁琳，等.外科重症新生儿侵袭性真菌感染的回顾分析[J].中国医院药学杂志，2021，41（3）：294-298.
[19] Calley JL，Warris A. Recognition and diagnosis of invasive fungal infections in neonates[J]. J Infect，2017，74（Suppl 1）：S108-S113.
[20] Hsu JF，Lai MY，Lee CW，et al. Comparison of the incidence，clinical features and outcomes of invasive candidiasis in children and neonates [J]. BMC Infect Dis，2018， 18（1）：194-205.
[21] 李燕，廖丹，蒙丹华，等.新生儿侵袭性真菌感染危险因素分析[J].中华妇幼临床医学杂志：电子版，2016，12（4）：390-394.
[22] 丁翔宇，贾晨虹，张古英，等.普外科婴幼儿侵袭性真菌感染的高危因素分析与评分系统建立[J].中国真菌学杂志，2020，15（6）：331-337，353.
[23] Yu YF，Du LZ，Yuan TM，et al. Risk Factors and Clinical Analysis for Invasive Fungal Infection in Neonatal Intensive Care Unit Patients [J]. Am J Perinatol，2013，30（7）：589-594.
[24] 陈丽，张伟丽，叶先飞，等.恶性血液病患者医院侵袭性真菌感染的危险因素分析[J].中国微生态学杂志，2015， 27（4）：417-420.
[25] 刘瞳瞳，杜琨.早产儿侵袭性真菌感染的危险因素[J].中国真菌学杂志，2020，15（6）：381-384.
[26] 雒晓科，张旭鹏，叶会丽，等.基于循证医学方法研究儿童肺部侵袭性真菌感染的危险因素[J].中国现代应用药学，2020，37（6）：703-707.
京公网安备 11010502046598号