Comparison of fungal and nonfungal infections in a broad-based surgical patient population
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Published on: July 1, 2020
Michael G Hughes1, Tae W Chong, Robert L Smith
1Department of Surgery, Surgical Infectious Disease Laboratory, University of Virginia, Charlottesville, Virginia 22908, USA. mgh6a@virginia.edu
Background:
Our aim was to compare fungal and nonfungal infections among a diverse surgical patient population.
Methods:
Data on all hospital-acquired infectious episodes among surgical intensive care unit and ward patients were collected prospectively over six years at a single university hospital. The relationships between fungal and nonfungal infection and over 100 variables were examined using univariate and multiple logistic regression analysis.
Results:
During the study period, 3,980 infectious episodes were identified; 554 were associated with fungal infection. Multiple logistic regression analysis demonstrated that markers of severity of acute illness (higher APACHE II scores and white blood cell counts, greater transfusion of cellular blood products, mechanical ventilator dependency, and prior infection) predicted fungal infection, whereas markers of chronic illness (comorbidities) did not independently predict either fungal or nonfungal infection. Patients with fungal infection were treated with more antibiotics for longer periods of time, had prolonged lengths of stay, and more often died compared with nonfungal infection patients. A separate multiple logistic regression analysis demonstrated that both fungal infection and the number of fungal sites of infection independently predicted mortality. Of all fungal isolates, only Candida albicans and Aspergillus spp. independently predicted mortality.
Conclusions:
Fungal infections differ significantly in character and outcomes from nonfungal infections among surgical patients.
Insights
Fungal infections in surgical patients are linked to acute illness severity, not chronic conditions. These infections lead to longer hospital stays, more antibiotic use, and higher mortality rates compared to nonfungal infections.
Area of Science:
- Infectious Diseases
- Surgical Critical Care
- Mycology
Background:
- Hospital-acquired infections pose significant risks in surgical settings.
- Understanding the distinct characteristics of fungal versus nonfungal infections is crucial for patient management.
Purpose of the Study:
- To compare fungal and nonfungal infections in a diverse surgical patient population.
- To identify predictors of fungal infections in surgical patients.
- To analyze the outcomes associated with fungal infections in surgical patients.
Main Methods:
- Prospective data collection of hospital-acquired infections over six years in a university hospital.
- Analysis of over 100 variables using univariate and multiple logistic regression.
- Comparison of clinical characteristics, treatment, and outcomes between fungal and nonfungal infections.
Main Results:
- Fungal infections were predicted by markers of acute illness severity (e.g., APACHE II scores, white blood cell counts), not chronic comorbidities.
- Patients with fungal infections experienced longer hospital stays, increased antibiotic use, and higher mortality.
- Candida albicans and Aspergillus spp. were the fungal isolates independently associated with mortality.
Conclusions:
- Fungal infections present distinct clinical features and outcomes compared to nonfungal infections in surgical patients.
- Severity of acute illness is a key factor in the development of fungal infections post-surgery.
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