严重创伤术后继发真菌感染情况耐药特征及影响因素分析

doi:10.3969/j.issn.1006-6233.2024.10.013

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Abstract Objective: To investigate the incidence of secondary fungal infections following surgery for severe trauma, their drug resistance characteristics, and influencing factors. Methods: A retrospective analysis was conducted on 516 severe trauma patients admitted to the Emergency Department of the First Affiliated Hospital of Air Force Medical University between April 2017 and March 2024. Patients were divided into an infection group (n=145) and a non-infection group (n=371) based on the presence of postoperative fungal infections. The fungal species distribution and drug resistance in the infection group were analyzed, and clinical data were collected for both groups. Logistic regression analysis was performed to identify risk factors, and ROC curves were plotted using the probabilities from the regression equation. Results: A total of 163 fungal strains were isolated from 145 patients in the infection group, with the highest proportion being Candida albicans (84 strains, 51.53%). The main infection sites were the respiratory tract, urinary tract, and surgical sites. Among the 163 strains tested for drug sensitivity, the highest resistance was to itraconazole (26 strains), while the least resistance was observed for flucytosine and amphotericin B (1 strain each). Univariate analysis revealed that factors such as Injury Severity Score (ISS), Sequential Organ Failure Assessment (SOFA) score at admission, duration of invasive ventilation, use and duration of urinary catheters, use of central venous catheters, continuous renal replacement therapy (CRRT), use of corticosteroids, use of antibiotics for ≥7 days, blood glucose levels, blood transfusions, ICU stay duration, and shock at admission were associated with postoperative fungal infections in severe trauma patients (P<0.05). Multivariate logistic regression showed that ISS score, SOFA score, duration of invasive mechanical ventilation, urinary catheter use and its duration, use of central venous catheters, use of corticosteroids, blood transfusion, and ICU stay duration were significant factors influencing postoperative fungal infections (P<0.05). ROC analysis indicated that the AUCs for ISS score, SOFA score, duration of invasive ventilation, urinary catheter use, urinary catheter use for ≥5 days, central venous catheter use, corticosteroid use, antibiotic use for ≥7 days, blood transfusion, and ICU stay duration were 0.754, 0.867, 0.867, 0.680, 0.727, 0.613, 0.616, 0.571, 0.601, and 0.762, respectively. The combined AUC for predicting postoperative fungal infections was 0.992, with a 95% confidence interval of 0.986~0.999, sensitivity of 0.966, and specificity of 0.984, which showed a significant difference compared to Az=0.5 (P<0.05). Conclusion: Candida albicans is the most common fungal strain causing secondary infections following surgery for severe trauma. Fungi show lower sensitivity to itraconazole and higher sensitivity to flucytosine and amphotericin B. Important factors influencing postoperative fungal infections include ISS score, SOFA score at admission, duration of invasive ventilation, use and duration of urinary catheters, use of central venous catheters, use of corticosteroids, blood transfusions, and ICU stay duration.

Key words： Emergency trauma surgery Fungal infection Drug resistance Influencing factors Perioperative

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.10.013 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I10/1653

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