The clinical characteristics of 70 cases of fungemia

OBJECTIVE: To evaluate the etiological and clinical characteristics of fungemia in Peking Union Medical College Hospital. METHODS: Microbial and clinical information of patients with fungemia consulted in Peking Union Medical College Hospital during 2008 to 2010 were retrospectively analyzed. RESULTS: A total of 70 patients were diagnosed with fungemia, and 100% of them had underlying diseases or potential risk factors. Of them, 40 (57.1%) patients were monomicrobial fungemia, and the other 30 (42.9%) patients with positive blood cultures were caused by at least two different microbes during hospitalization. Among 122 strains of microbes isolated from blood cultures, 72 were fungi and 50 were bacteria. Among the isolated fungi, 61 (84.7%) were Candida species, 31 (50.8%) were Candida albicans and 30 (49.2%) were non-albicans. According to the colonization or infected sites other than blood of the isolated fungi, 35 cases (50.0%) were primary fungemia; 18 (25.7%) were colonizing at lower respiratory tract simultaneously; 10 (14.3%) caused central-line related fungemia; 3(4.3%) were secondary to intra-abdominal fungal infection; and another 4 (5.7%) isolates had multiple colonization sites. During hospitalization, 37 cases died with a crude mortality rate of 52.9%, and 22 (32.9%) died of fungemia itself. In single factor analysis, ICU hospitalization (χ(2) = 15.136, P < 0.001), operation history within 30 days (χ(2) = 3.540, P = 0.060) and invasive mechanical ventilation (χ(2) = 4.450, P = 0.035) were related to crude mortality. Bacteremia during hospitalization (χ(2) = 5.657, P = 0.017), circulatory underlying diseases (χ(2) = 3.399, P = 0.065) and ICU treatment (χ(2) = 4.955, P = 0.026) increased attributable mortality. In the multivariate analysis, ICU history increased mortality during hospitalization, however, the operation history within 30 days was independently irrelevant to crude mortality during hospitalization. ICU history and bacteremia during hospitalization were independently correlated to attribution mortality of the patients with fungemia. CONCLUSIONS: Fungemia, usually accompanied with bacteremia, occurs often in the patients with underlying diseases. Patients with fungemia have poor prognosis and more than 50% patients die. ICU history increases the risk both to crude and attributable mortality. The patients with fungemia who had polymicrobial bloodstream infection have a higher attribution mortality. Operation history within 30 days is independently negatively correlated to attributable mortality.