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[Retrospective analysis of 15 patients with fungal septicaemia]
1Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Objective:
Study on the early diagnosis, antifungal therapy, and prophylaxis for fungemia.
Method:
Retrospective study of the clinical features, treatment and outcome of 15 patients with fungemia from August 1992 to September 2000 at Peking Union Medical College Hospital.
Results:
The patients' ages ranged from 25 days (1 newborn) to 72 years (mean: 54.5 years in 14 patients); 11 were male. The length of hospitalization before fungemia varied from 7 days to 12 months (median: 1.5 months) in 14 patients who fulfilled criteria for nosocomial fungemia, another one with fungemia occurred outside of hospital. The main underlying conditions were: malignant disease (cancer, leukemia and acute aplastic anemia) in 10 patients (66.7%), infections following abdominal surgery in 2 patients (13.3%), trauma in 1 patient, rheumatic heart disease in 1 patient and 1 newborn. In this group the risk factors for fungemia included: prior antimicrobial therapy (14 of 15, 93.3%), steroids/cytotoxic chemotherapy (11 of 15, 73.3%), neutropenia (4/15, 26.7%), central venous catheterization and hyperalimentation (2 of 15, 13.3%). There were two or more risk factors in each of 11 patients. Fungal species isolated from 15 patients were: C. albicans (in 4), C. tropicalis (in 3), C. parapsilosis (in 3), C. sake (in 1), Trichosporon beigelii (in 1) and Yeast-like fungus (in 3). Before or during of fungemia, there were abnormal pulmonary signs or chest roentgenogram in 11 (73.3%), thrush in 2 (13.3%), enteritis in 2 (13.3%), urinary tract infection in 2 (13.3%) and endocarditis in 2 (13.3%). The overall mortality was 53.3% (8 of 15) and was 26.7%(4 of 15) duo to fungemia. Out of 7 survived patients, 4 were cured, 3 with fluconazole (length of therapy: 3-5 weeks) and 1 with a combination therapy of amphotericin B plus fluconazole (length of therapy: 3 months), other 3 were improved with fluconazole or amphotericin B (length of therapy: > 2 weeks). During the antifungal therapy, 2 patients with the complication of fungal endocarditis underwent surgical removal of vegetation on the infected valves.
Conclusion:
In this study, the most frequent infectious agents were Candida albicans and non-albicans Candida species. Early diagnosis is of importance to guide appropriate antifungal therapy and reduce mortality.
Insights
Early diagnosis and appropriate antifungal therapy are crucial for improving outcomes in patients with fungemia, a bloodstream fungal infection. This study highlights common causative agents and risk factors, emphasizing the need for prompt intervention to reduce mortality.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Fungemia, a serious bloodstream fungal infection, poses a significant challenge in healthcare settings.
- Patients with underlying conditions like malignant diseases, post-surgical infections, or trauma are at higher risk.
- Risk factors include prior antimicrobial therapy, immunosuppression, neutropenia, and invasive devices.
Purpose of the Study:
- To investigate the early diagnosis, antifungal treatment, and prophylaxis strategies for fungemia.
- To analyze the clinical features, treatment outcomes, and mortality associated with fungemia.
- To identify common fungal species responsible for fungemia and associated risk factors.
Main Methods:
- A retrospective study was conducted on 15 patients diagnosed with fungemia between August 1992 and September 2000.
- Clinical data, including patient demographics, underlying conditions, risk factors, isolated fungal species, and treatment outcomes, were analyzed.
- Mortality rates and the effectiveness of antifungal therapies were assessed.
Main Results:
- Candida albicans and non-albicans Candida species were the most frequent causative agents.
- Common risk factors included prior antimicrobial therapy (93.3%), immunosuppression (73.3%), and neutropenia (26.7%).
- The overall mortality rate was 53.3%, with 26.7% of deaths directly attributed to fungemia. Effective treatments involved fluconazole and amphotericin B, with some cases requiring surgical intervention for complications like endocarditis.
Conclusions:
- Early and accurate diagnosis of fungemia is critical for effective management.
- Prompt initiation of appropriate antifungal therapy, guided by species identification, can significantly reduce mortality.
- Identifying and mitigating risk factors are essential for preventing fungemia in vulnerable patient populations.