Clinical Characteristics And Susceptibility Factors Of End-stage Liver Disease With Nosocomial Fungal Infection

Objective To analyze the incidence of end-stage liver disease with nosocomial fungal infection,the site of infection,and common pathogens,and to explore the risk factors of end-stage liver disease with nosocomial fungal infection,so as to effectively reduce the incidence of end-stage liver with nosocomial fungal infection.Provide evidence for prevention and treatment of end-stage liver disease with fungal infection in the hospital.Methods The object of study is: in January 2011 to January 2019 visits of General Hospital of Ningxia Medical University hospital patients with end-stage liver disease,according to whether there is a merger nosocomial fungal infection,divided into fungal infection and the fungal infection group,then collected the clinical data,analysis and discussion combined incidence of nosocomial fungal infection in patients with end-stage liver disease,easy to see the infection,susceptible to common pathogens and related factors.Results There were 698 hospitalized patients with end-stage liver disease,137 patients with end-stage liver disease with nosocomial fungal infection,the fungal infection rate was 19.63%,the fungal infection frequency was 151 times,and 14 cases with two or more sites of fungal infection,accounting for 10.22% of the total number of infections.Common site infection: according to the incidence,there were 67 cases of respiratory tract fungal infection(44.37%),43 cases of oral fungal infection(28.47%),27 cases of intestinal fungal infection(17.88%),7 cases of urinary tract fungal infection(4.64%),3 cases of abdominal fungal infection(1.99%),and 1 case of blood fungal infection(0.66%).3cases(1.99%)were infected with unidentified fungal sites.A total of 103 fungal strains were isolated from end-stage liver disease complicated with nosocomial fungal infection.Eighty strains(77.67%)of Candida and 23 strains(22.33%)of Mould were isolated.Candida genera accounted for the highest proportion,including 45 strains of Candida albicans,accounting for43.69%,28 strains of unclassified Candida,accounting for 27.19%,4 strains of Candida glabrica,accounting for 3.88%,and 2 strains of Candida tropicalis,accounting for 1.94%.1strain of Portuguese Candida,accounting for 0.97%.17 strains of Aspergillus,accounting for16.50%,and 6 cases of unclassified mold,accounting for 5.83%.There were 3 strains of Aspergillus Niger,accounting for 2.91%,7 strains of Aspergillus fumigatus,accounting for6.80%,2 strains of Aspergillus flavus,accounting for 1.94%,and 5 cases of other unclassified Aspergillus,accounting for 4.85%.Single factor analysis results showed that the required hospitalization duration,diagnosis and treatment of patients with the invasive operation,long use of antibiotics,antibacterial drugs,hormone use,MELD score,ascites for end-stage liver disease patients with nosocomial fungal infection factors,the experimental data of TBIL,AST,ALT,PTA,INR has significant difference(P<0.05).The results of multivariate regression analysis clearly showed that the length of hospital stay,the invasive operation required for diagnosis and treatment,the duration of antibiotic application,combined use of antibiotics,hormone use,ascites and MELD score were the independent risk factors for end-stage liver disease complicated with nosocomial fungal infection.In the prognosis analysis,there was no significant difference between the group with end-stage liver disease combined with nosocomial fungal infection and the non-fungal infection group(P>0.05).The prognosis of the group with end-stage liver disease combined with nosocomial fungal infection was worse than that of the non-fungal infection group(P<0.05).The prognosis of decompensated cirrhosis with nosocomial fungal infection was worse than that of the non-fungal infection group(P<0.05).The prognosis of liver failure patients with nosocomial fungal infection was no different from that of the non-fungal infection group(P>0.05).In the stage stratified prognosis analysis of liver failure,the results showed that the prognosis of patients with fungal infection in early liver failure group was not significantly different from that of the non-fungal infection group(P > 0.05),while the prognosis of patients with fungal infection in middle and late liver failure group was worse than that of the non-fungal infection group(P<0.05).Conclusion The incidence of end-stage liver disease combined with nosocomial fungal infection was 19.63%.Respiratory tract is the most susceptible site,followed by intestinal tract and oral cavity.A total of 103 fungal strains were obtained,of which Candida was the most,followed by Mould,Candida albicans was the most,and Aspergillus was the most in Mould.The length of hospital stay,invasive operation,duration of antibiotics use,combined use of antibiotics,hormone use,MELD score,and ascites are the independent factors of end-stage liver disease complicated with nosocomial fungal infection.The prognosis of advanced liver cancer and decompensated cirrhosis complicated with nosocomial fungal infection is poor.According to the stage analysis of liver failure,the prognosis of patients with advanced liver failure in the fungal infection group was worse than that in the non-fungal infection group(P<0.05).