Objective To investigate the clinical characteristics and pathogen distribution of community-acquired pneumonia (CAP) combined with type 2 diabetes mellitus (T2DM), based on bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) test. Methods In this cross-sectional study, CAP patients with BALF mNGS test were screened from April 2023 to April 2024. The patients were divided into a single CAP group (CAP group) and a CAP combine with T2DM group (CAP+T2DM group). The data of demographics, underlying diseases, complications, and laboratory tests including blood routine, inflammatory parameters, liver and renal functions, random blood glucose (RGB), hemoglobin A1C (HbA1c), and BALF mNGS tests were collected and compared between the two groups. Results Ultimately, 86 patients were included, with 45 in the CAP group and 41 in the CAP+T2DM group. Compared with the CAP group, the CAP+T2DM group had higher platelet count [(272.44±128.57)×109/L vs. (215.00±100.06)×109/L], erythrocyte sedimentation rate [(75.63±35.19) vs. (59.69±34.47) mm/h], RGB [10.8 (9.1, 13.5) vs. 6.5 (5.8, 7.8) mmol/L], HbA1c [8.2% (7.3%, 8.5%) vs. 5.7% (5.5%, 6.1%)], and fungi infection rate (65.9% vs. 40.0%), and the differences were statistically significant between the two groups (P<0.05). Conclusion CAP patients with T2DM have increased levels of platelet and erythrocyte sedimentation rate, and are at higher risk for fungi infection, which potentially leads to worse outcome.
Objective To investigate the risk factors for secondary pulmonary fungal infection in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). And a visual tool using nomogram was developed and validated to assist in the clinical prediction of the probability of pulmonary fungal infection occurrence in AECOPD patients. Methods A retrospective cohort study method was used to collect AECOPD patients hospitalized in the Department of Respiratory, The First Affiliated Hospital of Chengdu Medical College from January 2021 to December 2021 as a training set. And AECOPD patients between January 2020 and December 2020 were collected as a validation set. Independent risk factors were determined through univariate, Lasso regression analyses. and multivariable logistic, A nomogram prediction model was constructed with these independent risk factors, and the nomogram was evaluated by receiver operating characteristic area under the curve (AUC), calibration curve, and decision curve analysis (DCA). Results The use of glucocorticoid, combined use of antibiotics, duration of antibiotic use and hypoalbuminemia were independent risk factors for secondary pulmonary fungal infection in AECOPD patients (all P<0.05). The training set and validation set of the constructed prediction model had an AUC value of 0.915 [95%CI: 0.891 - 0.940] and 0.830 [95%CI: 0.790 - 0.871], respectively. The calibration curve showed that the predicted probability was in good agreement with the actual observed probability of pulmonary fungal infection in AECOPD patients. The corresponding decision curve analysis (DCA) indicated the nomogram had relatively ideal clinical utility. Conclusions The result showed that the use of glucocorticoid, combined use of antibiotics, prolonged antibiotic therapy and hypoalbuminemia was independent risk factors for pulmonary fungal infection in AECOPD patients. The clinical prediction model for secondary pulmonary fungal infection in AECOPD patients constructed in this study has strong predictive power and clinical practicability.
【Abstract】ObjectiveTo investigate the relevant factors for fungal infection following pancreatoduodenectomy and offer the theoretical foundation for preventing the emergence of complications after operation． MethodsMedical records from 562 consecutive patients who underwent pancreatoduodenectomy in this hospital from 1995 to 2005 were retrospectively reviewed by using single factor and noncondition Logistic regression analyse. Results①Seventyeight patients (13.9%) developed invasive fungal infection. The most frequently isolated fungal were Candida albicans accounted for 67.0%， and followed by Candida glabrata, Candida papasilosis and Candida tropicalis and gastrointestinal tract was the most common infection site, followed by respiratory tract, abdominal cavity. ②Fungal infection occurred significantly more often in patients with the length of time in parenteral nutrition, antibiotic use or abdominal cavity complications. Conclusion The most common infection site and isolated fungal associated with pancreatoduodenectomy were gastrointestinal tract and Candida albicans. Abdominal cavity complications such as pancreatic fistula， biliary fistula and abdominal infection and extended use parenteral nutrition and antibiotic are the most important factors leading to invasive fungal infection after pancreatoduodenctomy. Eliminating the various risk factors will decrease the incidence of fungal infection.
Objective To analyze the risk factors associated with fungal infections in adult recipients after living donor liver transplantation (LDLT). Methods Data of 189 recipients from January 2006 to December 2012 who received LDLT at our center were retrospectively analyzed. Cox regression analysis was used to analyze the risk factors for postoperative fungal infections. Results Postoperative fungal infection was found in 12 recipients. The most common infectious site was lung, whereas the most common fungal pathogen was Candida albicans. Multivariate analysis suggested preoperative low albumin level [HR=0.792, 95%CI (0.694, 0.903), P=0.001], massive intraoperative red blood cell transfusion [HR=4.322, 95%CI (1.308, 14.277), P=0.016] and longer postoperative intensive care unit (ICU) stay [HR=3.399, 95%CI (1.004, 11.506), P=0.049] were the independent risk factors for postoperative fungal infections. Conclusions Lung is the most common fungal infection site after LDLT. Preoperative low albumin level, massive intraoperative red blood cell transfusion and longer postoperative ICU contribute to fungal infections after LDLT.
Objective To explore the diagnosis value of the low dose multi-slice spiral computed tomography (MSCT) imaging in pulmonary fungal infection in order to improve its diagnosis level. Methods CT manifestations of 106 cases of pulmonary fungal infection confirmed by operation, pathology, mycetes cultivation and follow-ups of clinical therapy were retrospectively analyzed. All cases underwent low dose MSCT examinations including CARE dose 4D and sinogram affirmed iterative reconstruction technology, and 6 cases underwent contrast-enhanced CT scanning. Results Among the basic MSCT findings of pulmonary fungal infection, they showed patch-nodular type in 54 cases, solid variant in 38 cases, and tumor type in 14 cases. In all cases, 91 cases displayed as mulifocality, 83 cases as polymorphism and 78 cases as polytropy. Among the 106 cases with comparative distinctive MSCT manifestations, bud of branch sign were showed in 39 cases, halo sign in 32 cases, wedge shape consolidation in 19 cases, ice needle sign in 15 cases, crescentic sign in 11 cases, air ring sign in 6 cases, and contra-halo sign in 4 cases. The nodules in the cavities were not enhanced in enhanced scan in 5 cases. Conclusions There are some distinctive MSCT findings in patients with pulmonary fungal infection. Pulmonary fungal infection can be diagnosed with typical MSCT findings in close combination with the clinical information.
Objective To investigate whether de-escalation antibacterial therapy would be helpful to antifungal treatment in patients with invasive pulmonary fungal infection( IPFI) .Methods A prospective study was conducted in 174 IPFI patients( male 106, female 68) in the Second Hospital of Hebei Medical University from January 2008 to July 2010. The clinical data was collected including symptoms, physical signs,microbiological results, treatment and prognosis, etc. The therapeutic results were compared between the patients who received or did not receive de-escalation antibacterial therapy. Results The predominant pathogenic fungus was Candida albicans, which accounted for 59. 7% of IPFI. The effect of antifungal therapy showed statistically significant difference between the patients who received de-escalation antibacterial therapy and the patients who did not ( 60. 0% vs. 34. 5% , P =0. 001) . Conclusion The deescalation use of antibacterial therapy would be helpful to antifungal efficacy.