Risk Factors and Drug Resistance Analysis of Central Venous Catheter-related Fungal Infections in Maintenance Hemodialysis Patients

Gai WANG; Qianfang CHEN; Jianna ZHANG; Fuling YAN; Xiaoqian YU; Yajuan LI

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Gai WANG, Qianfang CHEN, Jianna ZHANG, Fuling YAN, Xiaoqian YU, Yajuan LI. Risk Factors and Drug Resistance Analysis of Central Venous Catheter-related Fungal Infections in Maintenance Hemodialysis Patients[J]. Journal of Kunming Medical University.

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Risk Factors and Drug Resistance Analysis of Central Venous Catheter-related Fungal Infections in Maintenance Hemodialysis Patients

Department of Nephrology，The First Affiliated Hospital of Air Force Medical University，Xi 'an Shaanxi 710032，China

Received Date: 2026-03-23

Abstract

Abstract

Objective To investigate the risk factors for central venous catheter-related fungal infections in maintenance hemodialysis （MHD） patients, construct a risk nomogram prediction model, and analyze the distribution and drug resistance characteristics of pathogenic fungi.. Methods A retrospective study was conducted on 216 MHD patients with central venous catheterization admitted to the First Affiliated Hospital of Air Force Medical University from January 2024 to January 2025. Patients were divided into an infection group （n = 54） and a non-infection group （n = 162） based on the presence or absence of catheter-related fungal infection. Clinical baseline data were collected from both groups. Multivariate logistic regression analysis was used to identify independent risk factors for fungal infection. A nomogram prediction model was constructed using R software. The model performance was comprehensively evaluated by ROC curve, calibration curve, and decision curves. Simultaneously, pathogenic distribution and antimicrobial susceptibility testing were performed on 54 isolated fungal strains. Results A total of 54 fungal strains were detected, predominantly Candida albicans （44.44%）, Candida tropicalis （22.22%）, and Candida glabrata （18.52%）. The primary infection sites were the lungs （44.44%） and urinary tract （27.78%）. Multivariate Logistic regression analysis showed that catheterization duration, repeated catheterization, antimicrobial drug usage category, history of corticosteroid/immunosuppressant use, and white blood cell count（WBC） were independent risk factors for fungal infections in MHD patients （P < 0.05）. The nomogram model based on these factors achieved an area under the receiver operating characteristic curve （AUC） of 0.905（95% CI: 0.854～0.957）for predicting fungal infection. The calibration curve demonstrated good goodness of fit （χ² = 2.689, P = 0.952）. Decision curve analysis showed that the model provided high net benefit across risk threshold of 0.03-0.90, with a maximum net benefit of 0.12 （at risk threshold 0.15）. Detected fungi demonstrated 100.00% sensitivity to amphotericin B, 98.15% sensitivity to caspofungin and 5-fluorocytosine, while showing relatively lower sensitivity to fluconazole （77.78%） and itraconazole （75.93%）. Conclusion Catheterization duration, repeated catheterization, antimicrobial drug category, history of corticosteroid/immunosuppressant use, and WBC are independent risk factors for catheter-related fungal infections in MHD patients. The nomogram model established based on these indicators shows good predictive value. Since Candida albicans is the predominant pathogen, vigilance regarding azole resistance is warranted. Empirical therapy should prioritize amphotericin B or caspofungin.
- Maintenance hemodialysis,
- Central venous catheter,
- Fungal infection,
- Drug resistance,
- Intensive care

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