OBJECTIVE  To explore the risk factors for hospital-associated invasive candidiasis(HAIC)in adult patients and to find more effective preventive and control measures to reduce the risk of HAIC in adults.

METHODS  This was a matched case-control study (1∶2), in which basic information and possible influencing factors of patients in the case group (103 cases) and control group (206 cases) were retrospectively collected by a uniformly designed questionnaire from 2015-2019 in a three-A teaching hospital in Beijing; risk factors for the occurrence of HAIC in adults were analyzed by univariate analysis, multifactorial conditions logistic regression, and XGBoost model.

RESULTS  Multifactorial conditions logistic regression analysis showed that Candida colonization (OR= 16.539, 95%CI: 3.133-87.451), total parenteral nutrition(TPN) support(OR=12.582, 95%CI: 2.275-69.689), indwelling urinary catheter (OR=9.887, 95%CI: 1.912-51.025), indwelling central venous catheter(CVC) (OR=4.715, 95%CI: 1.316-16.942), using β-lactamase inhibitor combination antibiotics (OR=3.875, 95%CI: 1.513-9.955) and carbapenems (OR=3.788, 95%CI: 1.528-9.421) were independent risk factors for HAIC in adults. Analysis based on the XGBoost model showed that the top 7 importance scores in a descending order were the use of carbapenems (4.71), use of invasive ventilator (3.2), admission length to intensive care unit (ICU) (2.32), use of β-lactamase inhibitor combination (1.68), admission to ICU (1.54), Candida colonization (1.48), and surgery (1.42). Comparison of the predictive effects of the two models showed that the Area Under Curve (AUC) of the XGBoost model (0.77) was higher than that of the multifactor logistic regression model (0.72).

CONCLUSIONS  This study analyzes the risk factors for the occurrence of HAIC for the first time. The results show that Candida colonization in ICUs and the use of broad-spectrum antimicrobial drugs such as β-lactamase inhibitors, carbapenems and the combination should be focused in the future, so as to take more targeted preventive and control measures for HAIC.