[Fungal infection in patients with serious disease. Risk analysis of fungal infection].
Candidemia is still a major source of high morbidity and mortality in severely disease patients. However, the etiology and risk factor is still unknown.



To evaluate the risk factor of fungal infection in intensive care patients.



505 patients who stayed in the intensive care unit of the Critical Care Center, Kyorin University more than 10 days between May 1, 1997 to June 31, 1998 were studied. They were divided into 7 groups: 1) trauma (injury severity score<10), 2) burn (burn index<10), 3) cerebro-vascular disease (unconsciousness<JCS 10), 4) GI tract disease, 5) acute poisoning, 6) cardiac dysfunction, 7) sepsis and others. Background factors, such as ISS, AIS scores for various trauma sites, length of stay in ICU and length of ventilatory days, as well as the fungal culture derived from blood, sputum, urine and pharyngeal smear, and the serological diagnosis were compared for the seven groups.



Higher fungal detection was found in upper airways (oral and sputum culture), but little was detected in urine or blood samples. Groups in trauma, burn, GI tract disease and CVA disease showed a higher detection rate of fungal species and diagnosed fungal infection, while patients with association of severe chest injury, inhalation injury and coma were significantly higher in the fungal infection group, than those in the non-fungal infection (p<0.01). Length of stay in ICU and the length of respiratory days were significantly longer in the fungal infection group (p<0.001).



The frequency of fungal infection onset was higher in patients with severe ISS of 16 or higher, those who used the ventilator, had inhalation injury, severe burns (BI>15), were in a coma, and had severe injury of lung parenchyme with chest AIS 3 or higher. In these serious patients, it is necessary to make a rapid diagnosis and treatment based on the surveillance culture and serological examination of sputum and urine for occult fungal infection.
Tanaka
H
H
Dept. of Traumatology and Critical Care Medicine Kyorin University, 6-20-2 Shinkawa, Mitaka City Tokyo, 181-0004, Japan.
Huruhata
T
T
Gotou
H
H
Sakurai
M
M
Shimazaki
S
S
D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D005658:Fungi / Q000302:isolation & purification; D005936:Glucans / Q000097:blood; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D007902:Length of Stay; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012121:Respiration, Artificial / Q000009:adverse effects; D012306:Risk; D012720:Severity of Illness Index; D047071:beta-Glucans
D000935:Antifungal Agents; D015415:Biomarkers; D005936:Glucans; D047071:beta-Glucans; C033363:beta-1,3-glucan