Related Experiment Videos
Prognostic indicators in fungemia of the surgical patient
1Department of Surgery, University of Southern California School of Medicine, Los Angeles.
Objective:
The objective of this study is to identify prognostic factors affecting mortality in surgical patients with culture-proved fungemia and to examine how amphotericin B affects mortality after controlling for these factors.
Design:
The study is based on a retrospective logistic regression analysis of general surgical patients with blood cultures positive for fungi. We analyzed the patients' ages; whether they received triple antibiotics, had diabetes, had malignant neoplasia, received steroids, had concomitant bacteremia, or took antibiotics for greater than 7 days; and total dose of amphotericin B.
Setting:
The study was carried out at a university-based county hospital.
Patients:
Analysis of microbiology records for blood cultures that were positive for fungi from November 1987 to January 1992 revealed 63 general surgical patients. Patients with burns and those undergoing organ transplantation were excluded. Forty charts were complete and available for review.
Main Outcome:
Death was the outcome variable studied.
Results:
Stepwise logistic regression analysis of death revealed age to be a risk factor for mortality. Treatment with at least 210 mg of amphotericin B was associated with relative risk of death of 0.055.
Conclusion:
Amphotericin B is effective even at low doses at decreasing the mortality in surgical patients with fungemia. On the other hand, increasing age is associated with an increased risk of mortality. Found not to be associated were concomitant bacteremia, concurrent triple antibiotic therapy, malignant neoplasia, and steroid use.
Insights
This study found that amphotericin B effectively reduces mortality in surgical patients with fungemia. Increasing age is a significant risk factor for mortality in these patients.
Area of Science:
- Infectious Diseases
- Surgical Critical Care
- Mycology
Background:
- Fungal infections (fungemia) pose a significant mortality risk in surgical patients.
- Identifying prognostic factors is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify prognostic factors for mortality in surgical patients with fungemia.
- To evaluate the impact of amphotericin B on mortality, adjusting for identified risk factors.
Main Methods:
- Retrospective logistic regression analysis of general surgical patients with culture-proven fungemia.
- Data collected included patient demographics, comorbidities, and treatment details.
- Exclusion criteria: patients with burns or undergoing organ transplantation.
Main Results:
- Increasing age was identified as a significant risk factor for mortality.
- Treatment with a cumulative dose of at least 210 mg of amphotericin B was associated with a substantially reduced relative risk of death (0.055).
Conclusions:
- Amphotericin B demonstrates efficacy in decreasing mortality among surgical patients with fungemia, even at relatively low cumulative doses.
- Age is a key prognostic factor, with older patients facing higher mortality risks.
- Concomitant bacteremia, triple antibiotic therapy, malignant neoplasia, and steroid use were not found to be significantly associated with mortality in this cohort.