Meta-analysis on risk factors for combined pulmonary fungal infections and their drug resistance in patients with lung cancer
OBJECTIVE To systematically evaluate the risk factor of combined pulmonary fungal infections,and their drug resistance in lung cancer patients.METHODS Cross-sectional studies related to risk factors and drug re-sistance associated with pulmonary fungal infections in lung cancer were collected using computer searches of VIP,Wanfang database,CNKI,Web of Science,and PubMed databases,and literatures published from Jan.2012 to Dec.2022 was searched.The literature was evaluated for quality and information was extracted,and Meta-analy-sis was performed using R Studio software.RESULTS A total of 13 studies were included,including 4 157 pa-tients,of whom 837 had pulmonary fungal infection,with a fungal infection rate of 20.13％.The risk factors and ORs(Odds Ratio)promoting the development of fungal infections in patients were age＞65 years(OR=3.28,95％CI:1.04-10.28,P＜0.01),smoking(OR=2.22,95％CI:1.25-3.93,P＜0.01),complicated with di-abetes mellitus(OR=2.62;95％CI:1.33-5.1,P=0.03),length of hospital stay no less than two weeks(OR=3.61,95％CI:1.58-8.26,P＜0.01),the use of broad-spectrum antibiotics(OR=1.91,95％CI:1.50-2.44,P＜0.01),use of hormones(OR=2.22,95％CI:1.69-2.91,P＜0.01),radiotherapy and chemotherapy(OR=2.12,95％CI:1.70-2.64,P＜0.01).The common top 1-5 most susceptible fungi for pulmonary fungal infections were Candida ablans,Candida tropicalis,Candida glabrata,Candida krusei,and Aspergillus.Mu-cormycosis and Candida krusei were more resistant to fluconazole,ftraconazole and voriconazole,while respective fungi were less resistant to amphotericin B and flucytosine.CONCLUSION Combined fungal infections were more common in lung cancer patients,age,smoking,complicated with diabetes mellitus,length of hospital stay no less than two weeks,the use of broad-spectrum antibiotics,use of hormone and radiotherapy and chemotherapy were all risk factors for combined pulmonary fungal infections in lung cancer patients,and flucytosine and amphotericin B were prioritized for fungal medications in hospitals.
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