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An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
[Retrospective analysis of invasive fungal infection in surgical intensive care unit]
1Intensive Care Unit, Peking University People's Hospital, Beijing 100044, China. ls_lancet@yahoo.com.cn
Objective:
To conduct a retrospective analysis of the invasive fungal infection (IFI) in surgical intensive care unit (SICU).
Methods:
The IFI data of the patients who were admitted in SICU during January 2003 to December 2008 was retrospectively analyzed. A total of 3743 patients were admitted into SICU. Among them, 271 patient's SICU duration was more than 48 hours, who had fungi examination.
Results:
Seventy-five patients were diagnosed IFI, the morbidity was 2.00% (75/3743), the incidence of fungemia was 0.27% (10/3743), the mortality of IFI patients was 49.33% (37/75). The morbidity rate of each year was almost the same. The mortality of 2007 and 2008 was higher than before (both P < 0.05). Thirty-four of all the 75 IFI patients got urinary tract infected, 37 got fungal pneumonia, 10 got fungemia, 1 got catheter-related fungal infection, 2 got fungal infection in abdomen, 2 got biliary tract infected. Eighty-six fungi strains which caused fungal infection were spotted. Candida albicans was the most common isolate (46.51%). Other isolates were Candida glabrata (22.09%), Candida tropicalis (13.95%), Candida parapsilosis (8.14%), Candida krusei (3.49%), Trichosporon (4.65%), Aspergillus (1.16%). Assist ventilation, combination of bacterial infection, treatment by broad spectrum antibiotics or more than three kinds of antibiotics were the most important risk factors of IFI in SICU. Prophylactic antifungal treatment may be useful.
Conclusion:
The morbidity of IFI in our SICU was comparatively low, and the same of the incidence of fungemia. The mortality of IFI patients was markedly high. The main sites of infection were lung and urinary tract, and the pathogenic fungi strains were mostly Candidas. Assist ventilation, combination of bacterial infection, broad spectrum antibiotics treatment were the most important risk factors of IFI in SICU.
Insights
Invasive fungal infections (IFI) in surgical intensive care units (SICU) are uncommon but have high mortality. Key risk factors include ventilation and broad-spectrum antibiotics, with Candida species being the most frequent cause.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Mycology
Context:
- Surgical intensive care units (SICUs) are high-risk environments for patients.
- Invasive fungal infections (IFIs) pose a significant threat in critical care settings.
- Understanding IFI epidemiology in SICU is crucial for patient management.
Purpose:
- To analyze the incidence, characteristics, and outcomes of invasive fungal infections (IFIs) in a surgical intensive care unit (SICU).
- To identify the primary sites of infection, common fungal pathogens, and mortality rates associated with IFIs in SICU patients.
- To determine the significant risk factors contributing to the development of IFIs in this patient population.
Summary:
- A retrospective analysis of 3743 SICU admissions from 2003-2008 identified 75 cases of IFI (2.00% morbidity).
- Fungal pneumonia and urinary tract infections were most common, with Candida albicans being the predominant pathogen (46.51%).
- IFI mortality was high (49.33%), with increased mortality noted in 2007-2008. Risk factors included mechanical ventilation, co-infection with bacteria, and broad-spectrum antibiotic use.
Impact:
- The study highlights a low but severe burden of IFIs in SICU, emphasizing the need for targeted prevention and treatment strategies.
- Findings underscore the importance of early detection and management of IFIs, particularly in mechanically ventilated patients or those with bacterial co-infections.
- Identifying key risk factors can inform clinical practice and potentially reduce IFI-related mortality in SICU settings.
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