Abstract
Objective To analyse the predisposing factors associated with pulmonary fungal infections(PFI)in critically ill respiratory patients and to explore anticipatory management interventions under multidisciplinary collaboration.Methods A total of 165 patients treated in respiratory intensive care unit(RICU)of Beijing Ji shui tan Hospital from May 2022 to May 2024 were retrospectively included in the study,and the patients were divided into the PFI group(n=54)and the non-PFI group(n=111)according to their fungal infection status.The clinical data of the two groups were collected,the fungal distribution of the patients in the PFI group was analysed,the risk factors for secondary PFI in respiratory intensive care patients were analysed by logistic regression,the predictive model was established by the probability values fitted to the regression equations,and the accuracy of the predictive variables was analysed by plotting the ROC curves.Results A total of 67 strains of fungi were isolated from 54 patients in the PFI group,including 26 strains of Candida albicans,accounting for 38.81％.Logistic regression analysis showed that age,APACHE Ⅱ,diabetes mellitus,type Ⅱ expiratory failure,length of hospital stay,mechanical ventilation,invasive operations,use of broad-spectrum antibiotics for>2 weeks,ESR,and IL-1β were the independent risk factors for secondary PFI in respiratory critically ill patients(P<0.05);and ALB and Th17/Treg were the protective factors for it(P<0.05)The results of ROC curves showed that age,APACHE Ⅱ,diabetes mellitus,type Ⅱ expiratory failure,length of hospital stay,mechanical ventilation,invasive operation,use of broad-spectrum antibiotics for>2 weeks,ESR,ALB,IL-1β,Th17/Treg,and the combined prediction were statistically significant in predicting secondary PFI in respiratory critically ill patients(P<0.05);in which the combined prediction assessment secondary PFI in respiratory intensive care patients had an AUC=0.988,95％CI 0.977-0.999,sensitivity 1.000,and specificity 0.883.Conclusion Age,APACHE Ⅱ,diabetes mellitus,type Ⅱ expiratory failure,hospital stay,mechanical ventilation,invasive operation,broad-spectrum antibiotic use>2 weeks,ESR,and IL-1β were the ALB,Th17/Treg are the protective factors.Clinical treatment of respiratory critically ill patients should pay close attention to the assessment of the above factors and develop personalised anticipatory management interventions under multidisciplinary collaboration to reduce the incidence of PFI.关键词
肺部真菌感染/呼吸科重症患者/预见性管理干预措施/多学科协作/易感因素Key words
pulmonary fungal infection/respiratory intensive care patients/anticipatory management interventions/multidisciplinary collaboration/predisposing factors
