Risk Factors for Catheter-related Fungal Infections in Burn Patients and Their Correlation with TLR4 and NF-κB

Juanru HE; Yani ZHANG; Xiaochun JIAO; Yanning SI; Qin ZHOU

Article Contents

Article Navigation > Journal of Kunming Medical University > 2026 > Accepted Manuscript

Juanru HE, Yani ZHANG, Xiaochun JIAO, Yanning SI, Qin ZHOU. Risk Factors for Catheter-related Fungal Infections in Burn Patients and Their Correlation with TLR4 and NF-κB[J]. Journal of Kunming Medical University.

Citation:

Juanru HE, Yani ZHANG, Xiaochun JIAO, Yanning SI, Qin ZHOU. Risk Factors for Catheter-related Fungal Infections in Burn Patients and Their Correlation with TLR4 and NF-κB[J]. Journal of Kunming Medical University.

Citation:

PDF( 1094 KB)

Risk Factors for Catheter-related Fungal Infections in Burn Patients and Their Correlation with TLR4 and NF-κB

1.
First Ward of Burn and Skin Surgery，First Affiliated Hospital of PLA Air Force Military Medical University，Xi’an Shaanxi 710032
2.
Shaanxi Nursing Association，Xi’an Shaanxi 710032，China

Received Date: 2026-01-23

Abstract

Abstract

Objective To investigate the risk factors for catheter-related fungal bloodstream infections in burn patients and their correlation with toll-like receptor 4 （TLR4） and nuclear factor-kappa B （NF-κB）. Methods A retrospective analysis was conducted on clinical data of 110 burn patients who underwent catheter placement admitted to the Department of Burns and Plastic Surgery, First Affiliated Hospital of Air Force Medical University from March 2021 to February 2025. Patients were divided into infection group （n = 22） and non-infection group （n = 88） based on whether catheter-related fungal bloodstream infection occurred. Pearson correlation coefficient analysis was used to analyze the correlation between TLR4 and NF-κB and catheter-related fungal infection in burn patients. ROC curve were constructed to determine optimal cutoff values for TLR4 and NF-κB. Logistic regression model was used to analyze the risk factors and a decision tree model was established. Results Pearson correlation analysis showed that both TLR4 and NF-κB were positively correlated with catheter-related fungal infection in burn patients （r = 0.579, P < 0.001; r = 0.556, P < 0.001）. ROC analysis showed that the optimal cut-off values of TLR4 and NF-κB for predicting catheter-related fungal infection in burn patients were 2.65 and 1.75, respectively. Multivariate Logistic regression analysis showed that diabetes mellitus, burn area, catheterization duration, TLR4 and NF-κB were independent risk factors for catheter-related fungal infection in burn patients （P < 0.05）. Decision tree modeling revealed that TLR4 was the most important predictor, with a classification accuracy rate of 90.00%. Conclusion Diabetes, burn area, catheterization duration, TLR4, and NF-κB are independent risk factors for catheter-related fungal infections in burn patients. Special attention should be given to high-risk burn patients with these factors.
- Burns,
- Catheter-related fungal infection,
- Prevention,
- Risk factors,
- Toll-like receptor 4,
- Nuclear factor-kappa B

FullText(HTML)

References(25)

References

[1]	Kovács R, Majoros L. Antifungal lock therapy: An eternal promise or an effective alternative therapeutic approach?[J]. Lett Appl Microbiol, 2022, 74(6): 851-862. doi: 10.1111/lam.13653
[2]	Wang Y, Li Q, Shu Q, et al. Clinical epidemiology and a novel predicting nomogram of central line associated bloodstream infection in burn patients[J]. Epidemiol Infect, 2023, 151: e90. doi: 10.1017/S0950268823000766
[3]	Pongrácz J, Szabó T, Juhász E, et al. Epidemiology, risk factors and mortality of fungal bloodstream infection: 14Years of experience at a teaching hospital[J]. Mycopathologia, 2025, 190(4): 55. doi: 10.1007/s11046-025-00965-3
[4]	Spera A M, Folliero V, D’Amore C, et al. Nine-year surveillance of Candida bloodstream infections in a southern Italian tertiary hospital: Species distribution, antifungal resistance, and stewardship implications[J]. J Pers Med, 2026, 16(1): 17. doi: 10.3390/jpm16010017
[5]	Afanou A K, Mundra S, Fjeld Estensmo E L, et al. Divergent TLR2 and TLR4 activation by fungal spores and species diversity in dust from waste sorting plants[J]. Appl Environ Microbiol, 2023, 89(3): e01734-e01722.
[6]	Guldenpfennig C, Teixeiro E, Daniels M. NF-kB’s contribution to B cell fate decisions[J]. Front Immunol, 2023, 14: 1214095. doi: 10.3389/fimmu.2023.1214095
[7]	李琰光, 昌帅磊, 谢江帆, 等. 危重烧伤并发侵袭性真菌感染患者的临床特征及死亡危险因素分析[J]. 中华烧伤与创面修复杂志, 2023(7): 618-624.
[8]	梁显南, 颜帅, 吉家聪, 等. 四肢深度烧伤患者创面感染的病原菌分布、危险因素分析及血清促炎因子水平变化的临床意义[J]. 现代生物医学进展, 2022, 22(16): 3143-3147.
[9]	中华医学会烧伤外科学分会, 郇京宁, 陈昭宏, 等. 严重烧伤患者深静脉置管操作和管理的全国专家共识(2020版)[J]. 中华烧伤杂志, 2021(2): 101-112. doi: 10.3760/cma.j.cn501120-20201122-00487
[10]	中华医学会重症医学分会. 血管内导管相关性血流感染预防与诊治指南(2025)[J]. 中华危重病急救医学, 2025, 37(3): 193-220. doi: 10.3760/cma.j.cn121430-20250301-00199
[11]	Miller A, Vujcich E, Brown J. Effect of central line duration and other risk factors on central line-associated bloodstream infection in severe adult burns patients at a large tertiary referral burns centre: A 5-year retrospective study[J]. Eur Burn J, 2022, 3(1): 18-26. doi: 10.3390/ebj3010003
[12]	Hou T, Bell W R, Mesa H. Invasive fungal infections of the head and neck: A tertiary hospital experience[J]. Pathogens, 2024, 13(7): 530. doi: 10.3390/pathogens13070530
[13]	Dudoignon E, Chevret S, Tsague S, et al. Risk factors and outcome associated with fungal infections in patients with severe burn injury: 10-year retrospective IFI-BURN study[J]. Clin Infect Dis, 2024, 79(3): 682-689. doi: 10.1093/cid/ciae337
[14]	刘薇, 程翔, 梁玉龙, 等. 不同烧伤面积患者创面感染病原菌分布及其耐药性[J]. 中国感染控制杂志, 2022, 21(1): 30-36.
[15]	俞国军, 王莽元, 张为民, 等. Stanford A型主动脉夹层患者术后血流感染病原菌分布及其影响因素的Logistic回归分析[J]. 现代生物医学进展, 2024, 24(9): 1668-1671, 1667. doi: 10.13241/j.cnki.pmb.2024.09.013
[16]	Wu H, Li C, Wang Y, et al. Transcriptomics reveals effect of Pulsatilla decoction butanol extract in alleviating vulvovaginal candidiasis by inhibiting neutrophil chemotaxis and activation via TLR4 signaling[J]. Pharmaceuticals, 2024, 17(5): 594. doi: 10.3390/ph17050594
[17]	Tang D, Cao X, Yuan B, et al. Correlation analysis between IL-1R/TLRs pathway and superficial dermatomycosis[J]. Eur J Med Res, 2025, 30(1): 191. doi: 10.1186/s40001-025-02434-5
[18]	刘燕, 马清昌, 徐伟, 等. TLR4、TREM1在烧伤感染患者血清中的表达水平及其诊断价值[J]. 广东医学, 2022, 43(2): 208-212. doi: 10.13820/j.cnki.gdyx.20212276
[19]	韩燕梅, 崔萍, 柏慧. 老年急性脑梗死患者肺部感染的病原学特征及与TLR4/NF-κB信号通路的相关性[J]. 中国实用医刊, 2023, 50(20): 43-46. doi: 10.3760/cma.j.cn115689-20230614-02385
[20]	高峰, 王兵, 赵瑞苓, 等. TLR4/MyD88/NF-κB通路在真菌性角膜炎中的表达和作用[J]. 中华医院感染学杂志, 2022, 32(2): 237-241. doi: 10.11816/cn.ni.2022-210464
[21]	王芳, 余锋, 姚豪杰, 等. 导管相关性真菌血流感染病原菌生物膜形成及预后影响因素[J]. 中华医院感染学杂志, 2022, 32(3): 408-411. doi: 10.11816/cn.ni.2022-210582
[22]	张成, 龚雅利, 罗小强, 等. 重度烧伤患者真菌血流感染的病原学特征分析[J]. 中华烧伤杂志, 2020(1): 37-41.
[23]	Li X, Yu B, Li H, et al. Drug clues for the treatment of fungal catheter-related bloodstream infection with antifungal lock therapy[J]. Drug Des Dev Ther, 2025, 19: 683-701. doi: 10.2147/DDDT.S501664
[24]	Cornely O A, Sprute R, Bassetti M, et al. Global guideline for the diagnosis and management of candidiasis: An initiative of the ECMM in cooperation with ISHAM and ASM[J]. Lancet Infect Dis, 2025, 25(5): e280-e293. doi: 10.1016/S1473-3099(24)00749-7
[25]	Bing J, Du H, Guo P, et al. Candida auris-associated hospitalizations and outbreaks, China, 2018–2023[J]. Emerg Microbes Infect, 2024, 13(1): 2302843.

Relative Articles(20)

Relative Articles

[1]	Cui MA, Qianjing ZHENG, Lijun WU, Yan NIE. Risk Factors Associated with Recurrence in Patients after Endoscopic Gastrointestinal Polypectomy and the Intervention Effect of the Informatized Hierarchical Management Model. Journal of Kunming Medical University,
[2]	Mengjiao ZHAO, Yanni JU. Correlation Between Serum NF-κB，S1P1，and SOCS3 Levels and Disease Severity in Children with Bacterial Infectious Pneumonia，and Their Prognostic Predictive Value. Journal of Kunming Medical University,
[3]	Shengxia ZHAO, Peipei LU, Yuan CHEN, Jinping SONG. Risk Factors of Cardiomyopathy in Patients with Diabetes and Their Correlations with the Levels of Serum FOXO1，GDF11 and MMP3. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250811
[4]	Lan LAN, Xuan XIAO. Analysis of Risk Factors and Gene Type Distribution of High Risk HPV Infection in 12688 Women Aged 18-60. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20250812
[5]	Xiaohua LI, Yalu FU, Dan WANG. The Levels of Serum CXCL5，TLR4，and MMP-3 in Gouty Arthritis Patients with Different Clinical Features and Their Correlation with the Joint Destruction and Serum Uric Acid Levels. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20251112
[6]	Meizi RAO, Xinyi JIANG, Jiarong MIAO. Analysis of Risk Factors for Co-Infection of Ulcerative Colitis with Epstein-barr Virus and Cytomegalovirus. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20241113
[7]	Liyan MENG, Chaoqun WANG, Xinghui CHEN, Junjing HE, Yaru NIU, Lisha MA. Risk Factors of Persistent HPV Infection in Patients with Early Cervical Cancer after Operation. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240422
[8]	Ruoyu WANG, Wei CHEN, Xun XU, Wende CAO, Yulan MIAO. Epidemiological Investigation and Risk Factors Analysis of Systemic Inflammatory Response Syndrome in 329 Children with Burn. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20240519
[9]	Yuqing XIE, Jun WANG, Xuebi JI, Ping WANG, Haifeng WANG, Xumin LI, Linya HUANG. Research Progress on Risk Factors and Risk Assessment of Urinary Tract Infection in Patients with Ureterostomy. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20231124
[10]	Shuangshuang WANG, Yaling LI, Liqin CHEN, Yonghui HAN, Mingbiao MA, Xiaojuan LI. The Analysis of Risk Factors and Drug Resistance of CRE Infection in Children’s Intensive Care Unit. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20230918
[11]	Ze-zu MENG, Hang XIAN, Xiao-jin HOU, Shi-lei WEI, Ji MA, Rui ZHAO, Rui Cong. Analysis of the Risk Factors Associated with Vascular Crisis after the Digits Replantation. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210122
[12]	Jia LIU, Yin HE, Xin LIU. Risk Factors and Nursing Strategies of PICC Catheter-related Infection in Tumor Patients. Journal of Kunming Medical University, doi: 10.12259/j.issn.2095-610X.S20210116
[13]	Li Jun . Analysis of Fatigue and Related Health and Safety Risk Factors Among Taxi Drivers in Kunming. Journal of Kunming Medical University,
[14]	Zhao Ying . . Journal of Kunming Medical University,
[15]	Liu Yi . . Journal of Kunming Medical University,
[16]	Xu Ying . . Journal of Kunming Medical University,
[17]	Yang Mao Lin . . Journal of Kunming Medical University,
[18]	Tan Xiang Lai . . Journal of Kunming Medical University,
[19]	Zhu Jing . The Potential Risk Factors Analysis of HIV/STD Infection in Vietnamese Cross-border Female Sex Workers. Journal of Kunming Medical University,
[20]	Zhang Xue Yu . The Correlation between Prevalence of Cardiovascular Diseases and Clustering of Risk Factors in Guandu District of Kunming. Journal of Kunming Medical University,