Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia

Unit of Mycology, 43/117, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark.
Journal of clinical microbiology (Impact Factor: 3.99). 06/2011; 49(9):3300-8. DOI: 10.1128/JCM.00179-11
Source: PubMed


This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates
and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included,
corresponding to 2/3 of the national episodes. Blood culture positivity varied by system, species, and procedure. Thus, cases
with concomitant bacteremia were reported less commonly by BacT/Alert than by the Bactec system (9% [11/124 cases] versus
28% [53/192 cases]; P < 0.0001), and cultures with Candida glabrata or those drawn via arterial lines needed longer incubation. Species distribution varied by age, prior antifungal treatment
(57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C. glabrata or C. krusei in hematology wards versus 27% occurrence in other wards; P = 0.002). Colonization samples were not predictive for the invasive species in 11/100 cases. Fifty-six percent of the patients
had undergone surgery, 51% were intensive care unit (ICU) patients, and 33% had malignant disease. Mortality increased by
age (P = 0.009) and varied by species (36% for C. krusei, 25% for C. parapsilosis, and 14% for other Candida species), severity of underlying disease (47% for ICU patients versus 24% for others; P = 0.0001), and choice but not timing of initial therapy (12% versus 48% for patients with C. glabrata infection receiving caspofungin versus fluconazole; P = 0.023). The initial antifungal agent was deemed suboptimal upon species identification in 15% of the cases, which would
have been 6.5% if current guidelines had been followed. A large proportion of Danish fungemia patients were severely ill and
received suboptimal initial antifungal treatment. Optimization of diagnosis and therapy is possible.

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    • "The standard of care for treating fungal biofilm infections on medical devices varies depending on the age and health status of the patient, the infection site, and the causative fungal species, but generally, the consensus on care involves administration of antifungal drugs and ultimately removal of the presumed infected medical device (Andes et al., 2012; Cornely et al., 2012; Lepak and Andes, 2011). The majority of fungal infections (deviceand non-device-associated) involve Candida species, and as such, current general guidelines for care tend to recommend treatments most effective against candidaemia and candidiasis (Arendrup et al., 2011; Mikolajewska et al., 2012). Four major classes of antifungal drugs are used for treatment of fungal infections: azoles, polyenes, nucleoside analogues, and echinocandins (Chen et al., 2011; Cowen, 2008; Jabra-Rizk et al., 2004; Mikolajewska et al., 2012; Ramage et al., 2012; White et al., 1998). "
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    • "In a previous European Confederation of Medical Mycology (ECMM) prospective multinational study performed in seven European countries, the rates of candidaemia ranged from 0.20 to 0.38 per 1000 hospital admissions [6]. Intensive care treatments accounted for about 40% of all episodes of candidaemia in various surveys conducted in Europe [2] [6] [7]. Moreover, two recent European studies documented the significance of fungal diseases in the intensive care setting [8] [9]. "
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    • "In recent point prevalence studies, a candidaemia incidence of 6.9 per 1000 ICU patients was reported, and 7.5% of ICU patients received antifungal therapy (Kett et al., 2011; Azoulay et al., 2012). Candidaemia increases mortality rates in the range of 20–49% (Gudlaugsson et al., 2003; Arendrup et al., 2011), but still there are many open management questions. Pulmonary candida infections may present as the manifestations of disseminated candidiasis spread by hematogenous route or as a primary bronchial or pulmonary process from the airways (Odds, 1988). "
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