Zhang Jingwen, Zhang Guoqiang, Wang JiaJia, Xiao Yun, Lu Xinxin, Lan Xunhong, Zhang Yan, Dai Zhang
Centre of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People's Republic of China.
Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, People's Republic of China.
Infect Drug Resist. 2024 Oct 16;17:4455-4466. doi: 10.2147/IDR.S480028. eCollection 2024.
Nosocomial candidemia is a life-threatening condition, and the incidence has increased in recent years. Thorough epidemiological data is still lacking in China.
A retrospective cohort study was conducted to investigate the patients admitted to Zhongshan Hospital Xiamen University from 1 January 2004 to 31 December 2022. This study included 205 individuals who were diagnosed with candidemia as subjects. Additionally, 303 cases with blood cultures were negative during the same period and were from the same department as a control group. We randomly assigned them to the training and validation groups in a 7:3 ratio. The least absolute shrinkage and selection operator regression, univariate and multivariate logistic regression analyses were used to filtrate independent factors associated with nosocomial candidemia. A nomogram model was established based on the selected variables. Receiver operating characteristic (ROC) curve, calibration plots and decision curve analysis (DCA) were used to evaluate clinical utility.
Two hundred and five nosocomial candidemia patients were reported, containing a high proportion of (n = 91,44.39%), followed by (n = 40, 19.51%), (n = 37,18.05%), (n = 23, 11.22%) and (n = 9,4.39%). Multiple organ dysfunction syndrome (OR = 10.372, 95% CI: 4.745-24.14 < 0.001), increased urea nitrogen of serum (OR=1.088,95% CI: 1.039-1.144 <0.001), decreased albumin of serum (OR = 0.922 95% CI: 0.850-0.997 =0.045), mechanical ventilation (OR=4.074,95% CI: 1.397-12.77 =0.012), central venous indwelling catheter (OR=7.422,95% CI: 3.189-18.41 <0.001) and solid tumor (OR = 3.036 95% CI: 1.276-7.359 =0.012) were identified as independent risk factors of candidemia. The area under the curve (AUC) of the nomogram model was 0.925 (95% CI: 0.898-0.952) in the training group and 0.946 (95% CI: 0.881-0.963) in the validation group. The calibration curve revealed good agreement between the probability and the observed values. DCA indicated that this nomogram might be clinically beneficial.
The nomogram including multiple organ dysfunction syndrome, elevated blood urea nitrogen, decreased albumin, mechanical ventilation, central venous indwelling catheter and solid tumor could provide reference value to clinicians for identifying nosocomial candidemia.
医院获得性念珠菌血症是一种危及生命的疾病，近年来发病率有所上升。中国仍缺乏全面的流行病学数据。
进行一项回顾性队列研究，调查2004年1月1日至2022年12月31日在厦门大学附属中山医院住院的患者。本研究纳入205例被诊断为念珠菌血症的患者作为研究对象。另外，同期选取303例血培养阴性且来自同一科室的患者作为对照组。我们按7:3的比例将他们随机分配到训练组和验证组。采用最小绝对收缩和选择算子回归、单因素和多因素逻辑回归分析来筛选与医院获得性念珠菌血症相关的独立因素。基于所选变量建立列线图模型。采用受试者操作特征（ROC）曲线、校准图和决策曲线分析（DCA）来评估临床实用性。
共报告205例医院获得性念珠菌血症患者，其中白色念珠菌比例较高（n = 91，44.39%），其次是热带念珠菌（n = 40，19.51%）、近平滑念珠菌（n = 37，18.05%）、光滑念珠菌（n = 23，11.22%）和季也蒙念珠菌（n = 9，4.39%）。多器官功能障碍综合征（OR = 10.372，95%CI：4.745 - 24.14，P < 0.001）、血清尿素氮升高（OR = 1.088，95%CI：1.039 - 1.144，P < 0.001）、血清白蛋白降低（OR = 0.922，95%CI：0.850 - 0.997，P = 0.045）、机械通气（OR = 4.074，95%CI：1.397 - 12.77，P = 0.012）、中心静脉留置导管（OR = 7.422，95%CI：3.189 - 18.41，P < 0.001）和实体肿瘤（OR = 3.036，95%CI：{1.276 - 7.359}，P = 0.012）被确定为念珠菌血症的独立危险因素。列线图模型在训练组的曲线下面积（AUC）为0.925（95%CI：0.898 - 0.952），在验证组为0.9 / 46（95%CI：0.881 - 0.963）。校准曲线显示预测概率与观察值之间具有良好的一致性。DCA表明该列线图可能具有临床应用价值。
包含多器官功能障碍综合征、血尿素氮升高、白蛋白降低、机械通气、中心静脉留置导管和实体肿瘤的列线图可为临床医生识别医院获得性念珠菌血症提供参考价值。
