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Dr. Adrian Man
Involvement of yeast species in fungaemia – an investigation of clinical data Annamária Földes, Doina-Veronica Bilca, Edit Székely, Farkas Enikő, Felicia Toma
Abstract: Invasive fungal infections have become increasingly prevalent in the recent decade and they have been associated with significant morbidity and mortality. Retrospective evaluation of mycological, clinical and epidemiological features of fungaemia episodes is important for the optimization of the diagnosis and treatment. Material and methods: Between August 2006 - 2008, 3284 blood cultures were processed using BacT/Alert Automated System (BioMérieux). We detected 23 fungaemia episodes from 23 patients (with 28 positive blood cultures sets). The mycological diagnosis was based on phenotypical analysis. A detailed retrospective-descriptive study was undertaken including 20 patients with available medical data. Results: The 23 fungaemia episodes were caused by: Candida albicans (n=8), Candida parapsilosis (n=7), Candida krusei (n=3), Candida glabrata (n=1), Candida norvegiensis (n=1), two other non-albicans Candida species and Trichosporon asahii (n=1). Isolates were detected from patients hospitalized in intensive care unit (ICU) (n=13), adult haematology unit (n=6), paediatric haematology unit (n=3), interventional cardiology unit (n=1). Encountered risk factors were as follows: prior antibiotics and acid-controlling agents (H2 antagonists and proton pump inhibitors) use, more than four days presence in ICU, central venous catheters, mechanical ventilation and administration of immunosuppressive drugs. Seven patients with severe marrow aplasia developed fungaemia. The infection with C. parapsilosis was definitely catheter-related in four children. At the time when fungaemia was detected five patients were already receiving antifungal treatment. Death occurred in 14 out of the 20 fungaemic patients. Conclusions: 1. This study demonstrates the increased involvement of non-albicans Candida species and the emergence of an opportunistic fungal pathogen: Trichosporon asahii in our hospital fungaemia episodes. 2. As adequate treatment is essential, rapid species diagnosis and in vitro susceptibility testing to antifungal agents by standardized methods is important. 3. Aggressive antibiotic treatment preceded fungaemia in all patients, therefore we consider that implementation of an adequate policy is necessary in order to optimize antibiotic use. Keywords: fungaemia,Candida spp.,diagnosis,epidemiology |
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Földes A, Bilca DV, Székely E, Enikő F, Toma F. Involvement of yeast species in fungaemia – an investigation of clinical data. Rev Romana Med Lab. 2008;13(4):49-58
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