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The pattern of fungal infections in critically ill surgical patients
E E Cornwell1, H Belzberg, T V offne
1Los Angeles County + University of Southern California Medical Center 90033-4525, USA.
Abstract:
There continues to be difficulty making the clinical distinction between fungal colonization and systemic infection in critically ill surgical patients. This distinction is important, given the potential risks of aggressive antifungal therapy. In order to evaluate the significance of fungal infections by various sites, we retrospectively reviewed the clinical courses of patients with cultures positive for fungi (Candida species or Torulopsis glabrata) in the SICU of LAC + USC Medical Center from January 1992-December 1993. There were 129 patients who were culture positive for Candida (110 patients) or Torulopsis glabrata (19 patients). There were 187 positive cultures. Fifty-five patients (43%) had systemic fungal infections (two or more sites, or fungemia). The proportion of patients with positive cultures from any given site going on to develop systemic infections was similar (wound, 49 per cent; urine, 54 per cent; sputum, 57 per cent; drain, 68 per cent; P = 0.61, NS). The mortality for SICU patients with systemic fungal infection was significantly increased (36.3% versus 10.5%, P < 0.05) when compared with SICU patients in general. No significant increase in mortality was seen in patients with single site isolation (13.5% versus 10.5%, P = 0.52). This study suggests that although systemic fungal infection is associated with increased mortality in SICU patients, no single site of isolation is superior to others in predicting which patients are likely to develop systemic infection. Prospective studies with antifungal agents with reduced toxicity are justified in patients with single site isolation.
Insights
Distinguishing fungal colonization from systemic infection in critically ill surgical patients is challenging. Systemic fungal infections significantly increase mortality, but no single culture site reliably predicts this outcome.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Clinical differentiation between fungal colonization and systemic infection in critically ill surgical patients remains difficult.
- Aggressive antifungal therapy carries potential risks, necessitating accurate diagnosis.
Purpose of the Study:
- To evaluate the significance of fungal infections originating from various sites in critically ill surgical patients.
- To determine if any single culture site is superior in predicting systemic fungal infection.
Main Methods:
- Retrospective review of clinical courses of patients with fungal cultures positive for Candida or Torulopsis glabrata.
- Analysis of data from the Surgical Intensive Care Unit (SICU) at LAC + USC Medical Center (January 1992-December 1993).
- Comparison of outcomes, including mortality, based on the presence and site of fungal isolation.
Main Results:
- 129 patients had positive fungal cultures (Candida or Torulopsis glabrata).
- 43% of patients developed systemic fungal infections (two or more sites, or fungemia).
- Systemic fungal infection significantly increased SICU mortality (36.3% vs. 10.5%, P < 0.05), while single-site isolation did not (13.5% vs. 10.5%, P = 0.52).
Conclusions:
- Systemic fungal infection is associated with increased mortality in SICU patients.
- No single site of fungal isolation reliably predicts the development of systemic infection.
- Prospective studies investigating less toxic antifungal agents for patients with single-site isolation are warranted.