Gonzalez C E, Venzon D, Lee S, Mueller B U, Pizzo P A, Walsh T J
Infectious Diseases Section, National Cancer Institute Bethesda, Maryland 20892, USA.
Clin Infect Dis. 1996 Sep;23(3):515-21. doi: 10.1093/clinids/23.3.515.
To define the risk factors related to the occurrence of fungemia in children infected with human immunodeficiency virus (HIV), we performed a matched case-control study. During a 6-year period (1987-1993), fungemia developed in 22 (6.3%) of 347 HIV-infected children observed at the Pediatric Branch of the National Cancer Institute. Each of these 22 cases was matched by age and gender with three controls. Multiple logistic regression indicated that the best predictor of fungemia in this population was the presence of a central venous catheter placed for > 90 days (P < .00001), followed by a group of risk factors composed of 10 independent variables adjusted for a CD4 cell count of < 100/MicroL (P < .045). Those variables included treatment with more than three antibiotics, treatment with more than three parenteral antibiotics, > 30 days of antibiotic treatment, bacterial infections, > 30 days in the hospital, hypoalbuminemia, C3 (Centers for Disease Control and Prevention) classification of HIV infection, and malnourishment. We conclude that prolonged placement of central venous catheters is the most important risk factors for fungemia in HIV-infected children and that the risk of fungemia is further influenced by antibacterial therapy, catheter manipulation, and host response.
为确定与感染人类免疫缺陷病毒（HIV）的儿童发生真菌血症相关的危险因素，我们进行了一项匹配病例对照研究。在6年期间（1987 - 1993年），国立癌症研究所儿科分部观察的347名感染HIV的儿童中有22名（6.3%）发生了真菌血症。这22例中的每一例均按年龄和性别与3名对照进行匹配。多因素逻辑回归分析表明，该人群中真菌血症的最佳预测因素是中心静脉导管留置时间>90天（P <.00001），其次是一组由10个独立变量组成的危险因素，这些变量在调整CD4细胞计数<100/μL后仍具有统计学意义（P <.045）。这些变量包括使用三种以上抗生素治疗、使用三种以上胃肠外抗生素治疗、抗生素治疗时间>30天、细菌感染、住院时间>30天、低白蛋白血症、HIV感染的疾病控制与预防中心（C3）分类以及营养不良。我们得出结论，中心静脉导管的长期留置是感染HIV儿童发生真菌血症的最重要危险因素，并且真菌血症的风险还受到抗菌治疗、导管操作和宿主反应的进一步影响。
