Etiology And Risk Factors Of Fungal Pneumonia In Respiratory Department

Objective:To investigate the etiological characteristics and risk factors of mycotic pneumonia in respiratory department.Methods:The data of patients with mycotic pneumonia and patients with non-mycotic pneumonia hospitalized during the same period in the Department of Respiratory and Critical Care Medicine of our hospital from October 2019 to October 2021 were analyzed,and the patients were divided into mycotic pneumonia and non-mycotic pneumonia groups.Gender,age,smoking,drinking history,albumin,hemoglobin,antibiotic use time and glucocorticoid use history were compared between the two groups,and the risk factors of fungal pneumonia were analyzed.To compare the value of mNGS and other tests in the diagnosis of mycotic pneumonia.Multivariate data association rule method was used to analyze the characteristics of fungal pneumonia with other pathogens in respiratory department.Results:The hospital stay and antibiotic use time of mycotic pneumonia group were longer than those of non-mycotic pneumonia group(P<0.05),and the hemoglobin level and serum albumin level of mycotic pneumonia group were lower than those of non-mycotic pneumonia group(P<0.05).The rates of mean age,diabetes,cerebral infarction,coronary heart disease,tumor,bronchiectasis,invasive procedure,glucocorticoid use history and smoking history in mycotic pneumonia group were higher than those in non-mycotic pneumonia group(P<0.05),but there was no statistically significant difference in the rates of gender and drinking history between the two groups(P>0.05).logistic regression analysis showed that the main risk factors of mycotic pneumonia were:advanced age,History of invasive operation,duration of antibiotic use,history of glucocorticoid use,and hypoproteinemia,among which the diagnostic value of age was superior to other factors.The positive predictive value of mNGS was 84.21%,and the negative predictive value was 76.67%.The positive predictive value of mNGS was 90.14% compared with 51.82%.In our study,the pneumocystis yersii,Aspergillus Niger,Rhizopus and Cryptococcus detected by mNGS were not detected by other tests.In conclusion,mNGS has a broader pathogen detection spectrum than other detection methods,and the application of mNGS improves the diagnosis of fungal pneumonia,especially mixed fungal infections.The analysis of association rules showed that Candida albicans mixed with Klebsiella pneumoniae,Aspergillus fumigatus mixed with Haemophilus parainfluenzae,Candida tropicalis mixed with Pseudomonas aeruginosa,and pneumocystis yerinii mixed with pseudomonas aeruginosa were more common,and the types of fungal infections in people with different underlying diseases were different.Conclusions:Clinical risk factors such as advanced age,long-term use of broad-spectrum antibiotics,glucocorticoids,history of invasive procedures,and hypoproteinemia should be considered for fungal pneumonia,and prophylactic antifungal therapy should be given if necessary.Pulmonary fungal infections are often mixed with bacteria,making early diagnosis difficult.However,mNGS plays an important role in the diagnosis of fungal pneumonia,with potential advantages in speed and accuracy.