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Fungal sepsis in surgical patients
Abstract:
Records of 65 surgical patients with positive fungal blood cultures were reviewed to address risk, overall mortality, and treatment. Negative urine cultures did not rule out sepsis. Staphylococcus epidermidis sepsis was present in 27 (42%) of the patients. In 70% of whom it occurred before or during fungemia. Increased mortality correlated with the use of multiple antibiotics, antibiotic use for prolonged periods, and with associated bacterial sepsis. Stopping antibiotic therapy did not reduce mortality. Amphotericin B reduced mortality in patients with dissemination, indicating that it is the treatment of choice for disseminated fungemia and that antibiotic therapy should not be discontinued when concomitant bacterial sepsis is present.
Insights
This study on fungal blood infections found that Amphotericin B is crucial for treating disseminated fungemia. It also highlights that stopping antibiotics doesn't lower mortality, even with bacterial sepsis.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Fungal bloodstream infections (fungemia) pose a significant clinical challenge, particularly in surgical patients.
- Co-infection with bacterial sepsis is common and complicates treatment strategies.
- The diagnostic utility of urine cultures in predicting fungemia is limited.
Purpose of the Study:
- To investigate the risk factors, mortality rates, and optimal treatment for fungemia in surgical patients.
- To evaluate the impact of concomitant bacterial sepsis on mortality and treatment outcomes.
- To determine the efficacy of Amphotericin B in treating disseminated fungal infections.
Main Methods:
- Retrospective review of medical records for 65 surgical patients with positive fungal blood cultures.
- Analysis of patient demographics, co-morbidities, antibiotic usage, and concomitant infections.
- Evaluation of treatment regimens, including Amphotericin B and antibiotic therapy, and their correlation with mortality.
Main Results:
- Staphylococcus epidermidis bacteremia preceded or coincided with fungemia in 70% of cases (27/65 patients).
- Increased mortality was associated with the use of multiple antibiotics, prolonged antibiotic exposure, and concurrent bacterial sepsis.
- Discontinuation of antibiotic therapy did not improve survival rates.
- Amphotericin B administration significantly reduced mortality in patients with disseminated fungemia.
Conclusions:
- Amphotericin B is the recommended treatment of choice for disseminated fungemia.
- Antibiotic therapy should be continued in patients with fungemia and concomitant bacterial sepsis.
- Negative urine cultures do not exclude the possibility of fungal sepsis.