Retrospective analysis of 15 patients with fungal septicaemia
Deng, G.; Wang, A.
Zhonghua Nei Ke Za Zhi 40(9): 594-596
2001
ISSN/ISBN: 0578-1426 PMID: 11758238 Document Number: 530988
Study on the early diagnosis, antifungal therapy, and prophylaxis for fungemia. Retrospective study of the clinical features, treatment and outcome of 15 patients with fungemia from August 1992 to September 2000 at Peking Union Medical College Hospital. The patients' ages ranged from 25 days (1 newborn) to 72 years (mean: 54.5 years in 14 patients); 11 were male. The length of hospitalization before fungemia varied from 7 days to 12 months (median: 1.5 months) in 14 patients who fulfilled criteria for nosocomial fungemia, another one with fungemia occurred outside of hospital. The main underlying conditions were: malignant disease (cancer, leukemia and acute aplastic anemia) in 10 patients (66.7%), infections following abdominal surgery in 2 patients (13.3%), trauma in 1 patient, rheumatic heart disease in 1 patient and 1 newborn. In this group the risk factors for fungemia included: prior antimicrobial therapy (14 of 15, 93.3%), steroids/cytotoxic chemotherapy (11 of 15, 73.3%), neutropenia (4/15, 26.7%), central venous catheterization and hyperalimentation (2 of 15, 13.3%). There were two or more risk factors in each of 11 patients. Fungal species isolated from 15 patients were: C. albicans (in 4), C. tropicalis (in 3), C. parapsilosis (in 3), C. sake (in 1), Trichosporon beigelii (in 1) and Yeast-like fungus (in 3). Before or during of fungemia, there were abnormal pulmonary signs or chest roentgenogram in 11 (73.3%), thrush in 2 (13.3%), enteritis in 2 (13.3%), urinary tract infection in 2 (13.3%) and endocarditis in 2 (13.3%). The overall mortality was 53.3% (8 of 15) and was 26.7%(4 of 15) duo to fungemia. Out of 7 survived patients, 4 were cured, 3 with fluconazole (length of therapy: 3-5 weeks) and 1 with a combination therapy of amphotericin B plus fluconazole (length of therapy: 3 months), other 3 were improved with fluconazole or amphotericin B (length of therapy: > 2 weeks). During the antifungal therapy, 2 patients with the complication of fungal endocarditis underwent surgical removal of vegetation on the infected valves. In this study, the most frequent infectious agents were Candida albicans and non-albicans Candida species. Early diagnosis is of importance to guide appropriate antifungal therapy and reduce mortality.