Abstract
BackgroundThe incidence of fungaemia has been increasing worldwide. It is important to distinguish non-Candida fungaemia from candidaemia because of their different antifungal susceptibilities. The aims of this study were to investigate the clinical characteristics of non-Candida fungaemia and identify the clinical factors that differentiate it from candidaemia.MethodsWe investigated the clinical manifestations and mortality of non-Candida fungaemia in Kyoto University Hospital from 2004 to 2009.ResultsThere were 110 episodes of fungaemia during the study period. There were 11 renal replacement therapy episodes of fungaemia due to non-Candida yeasts (10.0%), including 6 episodes with Cryptococcus neoformans, 4 with Trichosporon asahii, and 1 with Kodamaea ohmeri, in addition to 99 episodes of candidaemia (90.0%). The presence of collagen disease [odds ratio (OR) 9.00; 95% confidence interval (CI) 1.58-51.4; P = 0.01] or renal replacement therapy (OR 15.0; 95% CI 3.06-73.4; P < 0.01) was significantly more common in non-Candida fungaemia patients than in candidaemia patients. Prior colonisation by the species may be a predictor of non-Candida fungaemia. Non-Candida fungaemia had a higher mortality than candidaemia (54.5% versus 21.2%, P = 0.03).ConclusionsAlthough Candida species frequently cause fungaemia, we should also be aware of non-Candida yeasts because of their high mortality, particularly among high-risk patients, such as those with collagen disease and those under renal replacement therapy. Prior colonisation by the causative organisms may be an important predictor of non-Candida fungaemia.
Highlights
IntroductionIt is important to distinguish nonCandida fungaemia from candidaemia because of their different antifungal susceptibilities
The incidence of fungaemia has been increasing worldwide
Cryptococcus species are resistant to echinocandins, and Trichosporon species are characterised by resistance to amphotericin and echinocandins
Summary
It is important to distinguish nonCandida fungaemia from candidaemia because of their different antifungal susceptibilities. The incidence of hospital-acquired fungaemia caused by yeasts has increased dramatically during the past two decades [1]. This increased incidence has been associated with advances in clinical medicine, including organ transplantation, chemotherapy, antimicrobial agents, parenteral nutrition, and medical devices, all of which improve patient survival but increase the risk of infection [2]. Candida species are usually susceptible to standard antifungal agents. Cryptococcus species are resistant to echinocandins, and Trichosporon species are characterised by resistance to amphotericin and echinocandins For these reasons, early distinction between non-Candida species and Candida species is important
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