Study on Risk Factors of Invasive Fungal Infection of Lung in Children Based on Evidence-based Medicine

OBJECTIVE To evaluate the risk factors for invasive fungal infection(IFI) of lung in children, to provide evidence-based medical evidence for clinical treatment and infection management. METHODS Searched databases such as PubMed, Embase, Cochrane Library, CNKI, CMB, VIP and Wanfang database, and collected the randomized controlled trial (RCT) of risk factors for IFI in children from Jan. 2000 to Sep. 2018. The quality of the literature which was enrolled into the meta-analysis evaluated by Newcastle-Ottawa Quality Assessment Scale(NOS), and then meta-analysis was conducted by RevMan 5.2 software. RESULTS Total of 8 studies involving 7 203 patients were entered, 648 patients in IFI group and 6 555 patients in non-IFI group. Meta-analysis showed that antibiotics administration time(MD=2.14, 95% CI=1.42-2.87, P<0.001) and glucocorticoid administration time(MD=1.60, 95% CI=1.17-2.03, P<0.001) in IFI group were all significantly greater than that in the non-IFI group. The composition ratio of critical illness score <70 points(OR=3.18, 95%CI=2.58-3.93, P<0.001), antibiotic medication time >14 d(OR=3.22, 95%CI=2.58-4.02, P<0.001), glucocorticoid administration time >7 d(OR=7.81, 95%CI=5.63 10.83, P<0.001), invasive mechanical ventilation(OR=7.28, 95% CI=4.72-11.21, P<0.001), indwelling catheters (OR=2.55, 95% CI=2.06-3.14, P<0.001), malnutrition(OR=4.63, 95% CI=3.11-6.91, P<0.001) and diarrhea(OR=4.37, 95% CI=3.38-5.65, P<0.001) in IFI group were all significantly greater than that in the non-IFI group. CONCLUSION According to the strength of association, the risk factors for invasive pulmonary fungal infection in children are glucocorticoid administration time >7 d, invasive mechanical ventilation, malnutrition, diarrhea, antibiotic medication time >14 d, critical illness score <70 points and indwelling catheters.