Species distribution and associated risk factors of fungal infections in haemodialysis patients maintained with autologous arteriovenous endovascular fistulae

QI Qi; DONG Haonan; LI Yajuan

doi:10.3969/j.issn.1673-3827.2025.02.010

Abstract：Objective To investigate the species distribution of fungal infections and related risk factors in patients on ma-intenance haemodialysis using autologous arteriovenous endovascular fistulae.Methods Fifty-three patients with mainte-nance haemodialysis fungal infections admitted to our hospital from April 2022 to April 2024 were retrospectively selected as the infected group and identified by fully automated microbiological analyser,while 74 patients with simple maintenance hae-modialysis during the same period were randomly selected as the uninfected group,and autologous endovenous fistula vascu-lar access was used in both groups.Clinical data of the two groups were collected,and the risk factors of fungal infections in maintenance haemodialysis were analysed by multifactorial logistic regression model,the predictive value was assessed by u-sing the receiver operating characteristic curve(ROC),and the correlation was assessed by using Pearson's correlation coeffi-cient.Results Of the 53 patients with fungal infections on maintenance haemodialysis,lung infections predominated in 24(45.28%);58 strains of fungi were detected,of which 28 strains of Candida albicans(48.28%)accounted for the highest proportion;Multifactorial logistic regression showed that:length of hospital stay≥14 d(OR=9.035),duration of antibiot-ic use≥7 d(OR=7.387),comorbid diabetes mellitus(OR=5.098),white blood cell count(WBC)<4×109/L(OR=4.971),albumin(ALB)decreased(OR=1.066),haemoglobin(Hb)decreased(OR=2.875)were the risk factors for main-tenance haemodialysis fungal infections(P<0.05);ROC analysis showed that the duration of antibiotic use,ALB,Hb and co-prediction were all statistically significant for maintenance haemodialysis fungal infections(P<0.05);in which the area under the curve(AUC)of co-prediction for assessing maintenance haemodialysis fungal infections=0.995,with a 95%CI of 0.987 to 1.000,with a sensitivity of 0.981 and a specificity of 0.986;Pearson's correlation coefficients showed that the maintenance haemodialysis fungal infection status was significantly and positively correlated with length of hospital stay,du-ration of antibiotic use≥7 d,comorbid diabetes mellitus,and WBC<4×109/L(P<0.05),and significantly negatively correlated with decreased ALB,and decreased Hb(P<0.05).Conclusion Hospital stay≥14 d,antibiotic use≥7 d,com-bined diabetes mellitus,WBC<4×109/L,decreased ALB,and decreased Hb are the risk factors for fungal infections in pa-tients using autologous arteriovenous endovascular fistulae for maintenance haemodialysis,and measures should be taken for the above factors in order to actively prevent and reduce the incidence of fungal infections in the clinic.