Table 1.
Risk factors associated with invasive fungal infections.
| Risk Factors | Studies | OR (95% CI, p-Value) |
|---|---|---|
| Surgery | ||
| Any surgery | Blumberg et al., 2001 [50] | 7.3 (1–53.8, p = 0.05) |
| Multiple surgical procedures | McKinnon et al., 2001 [51] | Not reported, p ≤ 0.05 |
| Repeated abdominal surgery | Nagao et al., 2016 [24] | 5.2 (1–25.7, p = 0.046) |
| Surgery on ICU admission | León et al., 2006 [52] | 2.71 (1.5–5.1, p < 001) |
| Elective surgery | Jordà-Marcos et al., 2007 [53] | 2.75 (1.2–6.5, p = 0.02) |
| General abdominal surgery | Agvald-Öhman et al., 2008 [54] | 60.7 (7.3-infinity, p = 0.001) |
| Gastrointestinal procedure | Chow et al., 2008 [55] | 2.24 (1.5–3.4, p < 0.001) β |
| Major pre-ICU operation | Chow et al., 2008 [55] | 2.12 (1.1–4.0, p = 0.02) β |
| Major operation during ICU stay | Chow et al., 2008 [55] | 1.3, p = 0.04 α |
| Choledochojejunostomy | Collins et al., 1994 [56] Viehmann et al., 2016 [30] |
1.4, p = not reported 2.02 (0.45–9.07, p = 0.3) b 1.81 (0.99–3.32, p = 0.1) c |
| Transplant operation time (h) 9–10.9 ≥11 Transplant operation time |
Collins et al., 1994 [56] Viehmann et al., 2016 [30] |
0.9, p = not reported 2.8, p = not reported not reported, p = 0.55 b not reported, p < 0.01 c |
| Acute liver failure | Patel et al., 1996 [57] Shi et al., 2008 [58] |
3.0 (1.1–7.9, p = 0.030) not reported, p = 0.002 |
| CMV infection | ||
| CMV infection | Badley et al., 1996 [59] | 5.6 (2.5–12.7, p < 0.01) |
| Donor CMV+/recipient CMV- | George et al., 1997 [60] | 4.8 (2.0–11.8, p = 0.001) |
| CMV infection | George et al., 1997 [60] | 5.8 (1.8–18.4, p = 0.003) |
| CMV infection | Fortún et al., 2002 [61] | 9.4 (1.21–89.6, p = 0.01) |
| Total parenteral nutrition | ||
| Borzotta & Beardsley, 1999 [62] | Not reported, p < 0.001 | |
| Blumberg et al., 2001 [50] | 3.8 (1.9–7.6, p < 0.001) | |
| León et al., 2006 [52] a | 2.5 (1.2–5.3, p < 0.001) | |
| Jordà-Marcos et al., 2007 [53] a | 3.9 (1.7–8.8, p = 0.001) | |
| Total parenteral nutrition duration/days at risk | Chow et al., 2008 [55] | 11 (5.5–21.7, p < 0.01) α |
| Fungal Colonization | ||
| Candida species corrected colonization index | Pittet et al., 1994 [63] | 4.0 (2.2–7.5, p < 0.001) |
| Digestive focus | Ibàñez-Nolla et al., 2004 [64] | 20.2 (6.1–67.0, p < 0.001) |
| Non- Candida albicans at screening | Ibàñez-Nolla et al., 2004 [64] | 11.7 (1.9–70.6, p = 0.007) |
| Respiratory focus | Ibàñez-Nolla et al., 2004 [64] | 6.6 (1.3–34.3, p = 0.026) |
| Candida colonization | León et al., 2006 [52] a | 3.0 (1.5–6.4, p < 0.001) |
| Candida colonization | Jordà-Marcos et al., 2007 [53] a | 4.1 (1.8–9.3, p = 0.001) |
| Colonization index ≥ 0.5 | Agvald-Öhman et al., 2008 [54] | 19.1 (2.4–435, p = 0.017) |
| Renal replacement therapy | ||
| New-onset hemodialysis | Paphitou et al., 2005 [49] | 5.4 (2.5–11.8, p = 0.029) |
|
New-onset hemodialysis Hemofiltration |
Nagao et al., 2016 [24] Jordà-Marcos et al., 2007 [53] a |
8.1 (2.4–27.6, p = 0.001) 2.0 (1.1–3.6, p = 0.032) |
| Hemodialysis duration/days at risk | Chow et al., 2008 [55] | 3.8 (1.8–8.4, p < 0.001) α |
| 6.2 (2.7–14.4, p < 0.001) β | ||
| Infection/sepsis | ||
| Hospital acquired | Michalopoulos et al., 2003 [48] | 9.4 (2.5–48.3, p < 0.001) |
| Severe sepsis | León et al., 2006 [52] a | 7.7 (4.1–14.2, p < 0.001) |
| Enteric bacteremia | Chow et al., 2008 [55] | 3.5 (1.4–8.6, p < 0.01) α |
| 3.4 (1.4–8.4, p < 0.01) β | ||
| Mechanical ventilation | ||
| Mechanical ventilation after day 3 | McKinnon et al., 2001 [51] | Not reported, p ≤ 0.05 |
| Mechanical ventilation > 10 days | Michalopoulos et al., 2003 [48] | 28.2 (3.6–119.5, p < 0.001) |
| Diabetes | ||
| Michalopoulos et al., 2003 [48] | 2.4 (1.3–13.5, p < 0.01) | |
| Paphitou et al., 2005 [49] | 2.8 (1.6–4.7, p = 0.053) | |
| APACHE score | ||
| APACHE II score | Pittet et al., 1994 [63] | 1.0 (1.0–1.1, p = 0.007) |
| APACHE III score | Ibàñez-Nolla et al., 2004 [64] | 1.0 (1.0–1.1, p = 0.004) |
| Cardiopulmonary bypass time > 120 min | Michalopoulos et al., 2003 [48] | 8.1 (2.9–23.6, p < 0.01) |
| Acute renal failure | Blumberg et al., 2001 [50] | 4.2 (2.1–8.3, p < 0.001) |
| MELD score | ||
| MELD score | Alexander et al., 2006 [65] | 1.0 (1.0–1.1, p = 0.003) |
| MELD score 20–30 | Saliba et al., 2013 [20] | 2.1 (1.2–3.7, p = 0.012) |
| MELD score ≥ 30 | Saliba et al., 2013 [20] | 3.1 (1.6–6.0, p < 0.001) |
| MELD score ≥ 26 | Utsumi et al., 2019 [47] | 16.0 (3.0–118.3, p = 0.001) |
| Broad-spectrum antibiotics | Paphitou et al., 2005 [49] | 3.0 (1.8–5.0, p = 0.028) |
| Packed red blood cell transfusion | ||
| Chow et al., 2008 [55] | 2.0 (1.0–4.0, p = 0.06) α | |
| 2.7 (1.3–5.6, p < 0.01) β | ||
| Antifungal medication | ||
| Antifungal medication | Blumberg et al., 2001 [50] | 0.3 (0.1–0.6, p < 0.001) |
|
Prior use of antifungal therapy Central venous catheters |
Kim et al., 2019 [66] McKinnon et al., 2001 [51] |
13.6 (3.0–61.0, p < 0.001) Not reported, p ≤ 0.05 |
| Diarrhea | McKinnon et al., 2001 [51] | Not reported, p ≤ 0.05 |
| Peripheral catheter use | McKinnon et al., 2001 [51] | Not reported, p ≤ 0.05 |
APACHE: Acute Physiology and Chronic Health Evaluation; CMV: cytomegalovirus; CPB: cardiopulmonary bypass; ICU: intensive care unit; MELD: Model for End-Stage Liver Disease; α: OR for outcomes in Candida albicans; β: OR for outcomes in Candida non-albicans; a: data combined from both articles from the EPCAN Study; b: for superficial invasive fungal infections; c: for deep invasive fungal infections.