Objective: Study on the early diagnosis, antifungal therapy, and prophylaxis for fungemia.
Method: 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.
Results: 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.
Conclusion: 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.