Fungal sepsis: multisite colonization versus fungemia
Slotman, G.J.; Shapiro, E.; Moffa, S.M.
American Surgeon 60(2): 107-113
1994
ISSN/ISBN: 0003-1348 PMID: 8304640 Document Number: 430783
Patient management and outcome in critically ill patients with multiple sites of fungal colonization and/or fungaemia was evaluated retrospectively. Medical records of 36 fungaemic patients and 76 patients without fungaemia with 2 or more anatomic sites colonized, at the Cooper Hospital, New Jersey, USA, were reviewed. Of 126 patients (53 men, 59 women, aged 15-86 yr), 84 (74%) underwent 238 operations (41% elective, 59% emergent). Concomitant, non-fungal bacteraemia was present in 56 patients (50%). Candida albicans was the most common fungal pathogen isolated, followed by C. tropicalis, C. glabrata [Torulopsis glabrata], C. krusei, C. parapsilosis, Cryptococcus neoformans, Candida guilliermondii, Trichophyton rubrum and Aspergillus fumigatus. 71 patients (63%) received systemic antifungal therapy. Mortality differences between patients with fungaemia (17 of 36; 47%) and fungus-colonized patients (31 of 76; 41%) were not statistically significant. Amphotericin B treatment of fungaemia reduced mortality overall (26 vs. 71%, P<0.05) and compared with fungaemic patients receiving other antifungals (26 vs 50%, P<0.05). Among fungus-colonized patients, mortality was higher with amphotericin B than without (70 vs 36%, P<0.05) and was not changed by treatment with other antifungals (37 vs. 34%). Increased gastrointestinal operations, wound infections and intraperitoneal fungi and bacteria in fungus-colonized patients receiving amphotericin B suggested that these patients were the most critically ill. The mortality of multisite fungal colonization is as high as that of fungaemia. It is concluded that only amphotericin B improves survival in fungaemia, while the best treatment for multisite colonization is not clear from the data.