Factors associated with mortality in patients with fungaemia
Abstract number: P1576
Arendrup M.C., Sulim S., Holm A., Knudsen J.D., Nielsen L., Christensen J.J., Fuursted K., Johansen H.K.
Objective: A semi-national surveillance program of fungaemia in Denmark has revealed a notably high incidence. Therefore we have investigated the mortality, underlying conditions and host factors in fungaemic patients in 2006.
Methods: Participants are 6 departments of clinical microbiology serving the greater Copenhagen area and major parts of Zealand, Funen and Jutland (population 2,667,021). From each episode of fungaemia, a specimen is sent to the National Reference Laboratory for verification of species identification and susceptibility testing (EUCAST discussion document 7.1). A pro forma was provided to gather information on the patient, concomitant infections, treatment, procedures, and 30-day mortality, and on the time course of the mycological diagnosis. Fisher's exact test was used for comparison of mortality rates.
Results: A total of 316 episodes of fungaemia were recorded corresponding to a rate of 12/100,000 population. C. albicans encountered for 53% of the cases, C. glabrata for 21%, C. krusei for 8%, C. parapsilosis for 6% and C. tropicalis for 5%. 51% of the patients were at the ICU at the time of fungaemia, 56% had undergone surgery, which in most cases was abdominal (81%), while only 5% were leucopenic (<0.5 mia/L).
Overall 30 day-mortality was 38%, but 29% (81/280) among patients who received antifungal treatment. The mortality was higher in ICU patients, in the patients on mechanical ventilation (both 47%, P 0.0001) and in patients with leukocyte count of >10 mia/L (43%, P 0.0086). Mortality was not dependent on use of steroids, parenteral nutrition, dialysis, prior surgery or presence of underlying haematological disease. Species dependent mortality was C. krusei 36%, C. tropicalis 33%, C. glabrata 32%, C. albicans 28% and C. parapsilosis 25%, and a trend towards a higher mortality in the patients with C. glabrata fungaemia receiving fluconazole vs. caspofungin as first antifungal compound was observed (48% (12/25) vs. 17% (3/18) P 0.0521).
Conclusion: The incidence rate of fungaemia in Denmark is 3 times higher than reported in other Nordic countries and associated especially with ICU patients and patients with prior abdominal surgery. Mortality is highest in the sickest population, is associated with species and choice of initial antifungal treatment.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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