Xinyu Zuo, Xinyuan Ma, Miao Zhang, Richeng Mao, Jiexian Ma
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引用次数: 0
Abstract
Patients on immunosuppressive drugs or those who are critically ill are at high risk for invasive fungal infections (IFIs). The assessment of IFI risk and the initiation of prophylaxis in these patients remain unclear. A nomogram model was developed to evaluate clinical and immune indicators in relation to IFI risk and validated by immunocompromised patients. High-risk patients, as identified by the model, were selected for a prospective randomized study to assess the efficacy of the model and timing of fungal prophylaxis initiation. Patients deemed high risk received either fluconazole or a placebo until IFI occurrence or risk downgrade for 90 days. We compared the incidence of IFI and mortality between the two groups. The nomogram, created from a training cohort (n = 384), included age, IgG level, and CD4+ cell count as predictive indicators of IFI and was validated in a separate cohort (n = 281) with an area under the curve of 0.723. A total of 265 patients were recruited into the prospective study, with 163 high-risk patients randomly assigned to receive either fluconazole (n = 83) or a placebo (n = 80). The model had a positive predictive value of 48.8% and a negative predictive value of 90.2%. High-risk IFI defined by this model could be reduced to the low-risk cohort level with fluconazole prophylaxis (P < 0.01). This nomogram model reliably predicts the risk of IFI and timing of mycoprophylaxis in immunocompromised patients. Targeted mycoprophylaxis significantly reduces the incidence of IFI, particularly yeast infections, and may help to prevent fungal colonization.
Importance: We still lack enough evidence to decide when and how to begin fungal prophylaxis in immunocompromised patients. A model based on immune function indicator is an effective tool for predicting risk of invasive fungal infection (IFI) in immunocompromised patients. Patients were collected to evaluate the performance of the model retrospectively and prospectively.
Clinical trials: This study is registered with the Chinese Clinical Trial Registry as ChiCTR2400079810.
期刊介绍：
Microbiology Spectrum publishes commissioned review articles on topics in microbiology representing ten content areas: Archaea; Food Microbiology; Bacterial Genetics, Cell Biology, and Physiology; Clinical Microbiology; Environmental Microbiology and Ecology; Eukaryotic Microbes; Genomics, Computational, and Synthetic Microbiology; Immunology; Pathogenesis; and Virology. Reviews are interrelated, with each review linking to other related content. A large board of Microbiology Spectrum editors aids in the development of topics for potential reviews and in the identification of an editor, or editors, who shepherd each collection.
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