Han Yaopin, Zuo Yihui, Luo Zhe, Ju Minjie, Hua Jianlan, He Binfeng, Wu Yixing, Zhang Jing
Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Chin Med J Pulm Crit Care Med. 2023 Jun 7;1(2):113-118. doi: 10.1016/j.pccm.2023.04.005. eCollection 2023 Jun.
Candida species ( spp) are commonly isolated microorganisms from lower respiratory tract (LRT) specimens of patients with hospital-acquired pneumonia (HAP); however, the clinical significance remains controversial. This study aimed to investigate the correlation between spp. in the LRT and the clinical features and prognosis of HAP.
This retrospective analysis included eligible patients with HAP from the database of a prospective study carried out between 2018 and 2019 in nine Chinese hospitals. Data on demographics, clinical characteristics, and prognosis were collected and analyzed. Propensity score matching (PSM) was used to balance the baseline characteristics.
A total of 187 HAP patients were enrolled. After PSM of severity score, 27 cases with positive sputum culture of spp were compared with the control group at a ratio of 1:1. The -positive group had more bacterial isolates in blood culture than the -negative group (39.1% [9/23] . 7.7% [2/26], = 6.928, effect size [ES] = 0.38, 95% CI: 0.12-0.61, = 0.008). The proportion of patients with chronic lung diseases was significantly higher in the -positive group (55.6% [15/27] . 22.2% [6/27], = 6.312, ES = 0.34, 95% CI: 0.07-0.59, = 0.012). The 30-day prognosis of HAP was significantly different between the two groups (80.8% [21/26] . 38.5% [10/26], = 9.665, ES = 0.43, 95% CI: 0.19-0.66, = 0.002). Univariable logistic regression analysis showed that LRT spp colonization was a risk factor for 30-day mortality of HAP (OR = 6.720, 95% CI: 1.915-23.577, 0.003).
spp in the LRT was associated with 30-day mortality of HAP. Patients with chronic underlying lung diseases tend to have spp colonization.
念珠菌属是医院获得性肺炎（HAP）患者下呼吸道（LRT）标本中常见的分离微生物；然而，其临床意义仍存在争议。本研究旨在探讨LRT中的念珠菌属与HAP的临床特征及预后之间的相关性。
这项回顾性分析纳入了来自2018年至2019年在中国九家医院开展的一项前瞻性研究数据库中的符合条件的HAP患者。收集并分析了人口统计学、临床特征及预后的数据。采用倾向评分匹配（PSM）来平衡基线特征。
共纳入187例HAP患者。在对严重程度评分进行PSM后，将27例痰培养念珠菌属阳性的病例与对照组按1:1的比例进行比较。念珠菌属阳性组血培养中的细菌分离株比阴性组更多（39.1%[9/23]对7.7%[2/26]，χ² = 6.928，效应量[ES]=0.38，95%CI：0.12 - 0.61，P = 0.008）。慢性肺部疾病患者在念珠菌属阳性组中的比例显著更高（55.6%[15/27]对22.2%[6/27]，χ² = 6.312，ES = 0.34，95%CI：0.07 - 0.59，P = 0.012）。两组HAP的30天预后存在显著差异（80.8%[21/26]对38.5%[10/26]，χ² = 9.665，ES = 0.43，95%CI：0.19 - 0.66，P = 0.002）。单因素逻辑回归分析显示，LRT念珠菌属定植是HAP 30天死亡率的一个危险因素（OR = 6.720，95%CI：1.915 -
