Retrospective Analysis Of 480 Cases Of Community Acquired Mycoses

Background:The incidence and case fatality rate of invasive fungal diseases(IFD)are rapidly increasing.There are few literature reports on community-acquired invasive fungal diseases in China.Early identification of severe IFD patients is difficult and the mortality rate is extremely high.This study aims to analyze the clinical characteristics of community-acquired IFD and establish a prediction model for severe IFD,so as to provide reference for the diagnosis and treatment of IFD.Methods:A retrospective study was conducted in a tertiary teaching hospital with 2500 beds,and the clinical data of 480 inpatients diagnosed with community-acquired IFD from January 1,2010 to June 30,2021 were queried and analyzed.The epidemiology and basic clinical features of community-acquired IFD was analyzed and described.Then 480 subjects were randomly assigned to training set and validation set on a scale of 7:3.A prediction model for severe IFD was constructed with the least absolute shrinkage and selection operator(LASSO)regression and multivariate Logistic regression.Finally,receiver operating characteristic curve(ROC)and C index were used to ensure the discrimination ability of the model.Calibration curve and decision curve analysis(DCA)were used to clarify the predictive effect and clinical utility of the model.Results:Among the 480 IFD patients enrolled,Aspergillus(221[46%]),Cryptococcus(96[20%]),and Candida(43[9%])were the main pathogens.Endoscopic or direct surgical pathological examination of sterile specimens accounted for 80.4%of all diagnostic methods.Lungs(185[38.5%])and sinuses(184[38.3%])were the most commonly involved sites.Severe immunodeficiency[63 cases(43%)],malignant tumors[61 cases(39.3%)]and chronic kidney disease[62 cases(37.5%)]were the most common underlying diseases.Most of the patients were from department of otolaryngology head and neck surgery[186 cases(38.8%)],respiratory department[85 cases(17.7%)and thoracic surgery department[56 cases(11.7%).The incidence of community-acquired IFD generally were tend to increasing yearly,which increased by 4.7 times from 2010(0.27 cases/1000 hospitalizations)to 2021(1.28 cases/1000 hospitalizations).77 cases belonged to the severe group and 403 cases belonged to the non-severe group.The overall case fatality rate of community-acquired IFD was 6.7%.The mortality rate in the severe group was 41.6%,and no patient died in the non-severe group.Age,neutropenia,chronic heart disease,one or more comorbidities,respiratory symptoms,absolute white blood cell count,pneumocystis infection,central nervous system fungal infection,fungemia,and fungal peritonitis are predictive factors of severe IFD.The values of the prediction ’model in the training set and the validation set are 0.93 and 0.92.The effective predictive ability was also proved by analysis of the calibration curve and decision curve.Conclusion:The incidence of community-acquired IFD is annually increasing.Aspergillus and Cryptococcus are the most common community-acquired mycoses in this region.Clinical manifestations are various and often atypical.Patients with underlying diseases are more likely to progress to severe disease,and the case fatality rate of severe patients is as high as 41.6%.advanced age,neutropenia,chronic heart disease,one or more comorbidities,and respiratory symptoms(such as hemoptysis,dyspnea or cough,etc.),elevated white blood cell count,pneumocystis infection,fungal infection of the central nervous system,fungemia,fungal peritonitis are risk factors for severe IFD.