Hospital-acquired fungemia: Its natural course and clinical significance

Abstract

Eighty-five episodes of hospital-acquired fungemia in 77 adult patients were reviewed. The predominant risk factors associated with fungemia were prior antibiotic therapy (100 per cent), indwelling intravenous (100 per cent) and Foley catheters (97 per cent), concomitant bacterial infections (88 per cent), recent surgery (69 per cent) and parenteral hyperalimentation (66 per cent). The clinical picture was indistinguishable from sepsis of a bacterial origin. Laboratory data were nonspecific. Hence, diagnosis could only be made by blood culture. Patients followed one of four clinical courses: (1) spontaneous resolution of fungemia (42.8 per cent), (2) endophthalmitis after apparent spontaneous resolution of fungemia (5.1 per cent), (3) illness of a severity or duration requiring antifungal therapy (including the five patients in category 2) (36.3 per cent), or (4) no antifungal therapy and death from fungemia (20.7 per cent). Endophthalmitis was documented in 14 per cent of the patients with fungemia. The over-all mortality was 56 per cent whereas 29 per cent died as a result of fungemia. The data suggested that fungemia of a duration of greater than 72 hours, evidence of endophthalmitis or critically ill clinical status were all reasons for instituting amphotericin B therapy. Speciation of Candida organisms may be important, as patients with nonalbicans Candida fungemia were less likely to require antifungal therapy than patients with Candida albicans fungemia. All patients with fungemia require routine periodic ophthalmologic examinations.