Comparison of fungal and nonfungal infections in a broad-based surgical patient population.
BACKGROUND
Our aim was to compare fungal and nonfungal infections among a diverse surgical patient population.


METHODS
Data on all hospital-acquired infectious episodes among surgical intensive care unit and ward patients were collected prospectively over six years at a single university hospital. The relationships between fungal and nonfungal infection and over 100 variables were examined using univariate and multiple logistic regression analysis.


RESULTS
During the study period, 3,980 infectious episodes were identified; 554 were associated with fungal infection. Multiple logistic regression analysis demonstrated that markers of severity of acute illness (higher APACHE II scores and white blood cell counts, greater transfusion of cellular blood products, mechanical ventilator dependency, and prior infection) predicted fungal infection, whereas markers of chronic illness (comorbidities) did not independently predict either fungal or nonfungal infection. Patients with fungal infection were treated with more antibiotics for longer periods of time, had prolonged lengths of stay, and more often died compared with nonfungal infection patients. A separate multiple logistic regression analysis demonstrated that both fungal infection and the number of fungal sites of infection independently predicted mortality. Of all fungal isolates, only Candida albicans and Aspergillus spp. independently predicted mortality.


CONCLUSIONS
Fungal infections differ significantly in character and outcomes from nonfungal infections among surgical patients.
Hughes
Michael G
MG
Department of Surgery, Surgical Infectious Disease Laboratory, University of Virginia, Charlottesville, Virginia 22908, USA. mgh6a@virginia.edu
Chong
Tae W
TW
Smith
Robert L
RL
Evans
Heather L
HL
Pruett
Timothy L
TL
Sawyer
Robert G
RG
D018806:APACHE; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D002176:Candida albicans / Q000302:isolation & purification; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology*; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013997:Time Factors
D000900:Anti-Bacterial Agents