[Influence of the diagnosis and treatment guidelines for mycosis profunda (deep mycosis) in the field of emergency and critical care medicine--with reference to patient background].
OBJECTIVE
This study was designed to elucidate the present situation of diagnosis and treatment for mycosis in the field of emergency and critical care medicine following presentation of the diagnosis and treatment guidelines for deep mycosis (in February, 2003).


METHODS
In patients (administered antimycotics or who have pyrexia showing no response to any antimicrobial drug), medically examined and suspected of having had a fungal infection at 15 medical institutions throughout Japan, participating in the Japanese Society for the Study of Critical Care for Mycosis during the period from May 2003 through August 2004 and with facilities for emergency and critical care medicine, patient background, risk factors, contents of treatment, and patient outcomes were totaled and assessed.


RESULTS
The subjects of this assessment were 125 patients consisting of 87 (69.6%) men and 38 (30.4%) women. Their mean age was 59.6 years, and 36.8% were 70 years of age or older. Intravascular catheterization was conducted in 78.4% of the 125 subjects. Antimycotics were administered to 89 patients, and the frequencies of fluconazole (FLCZ) for the initial administration and during the period of data registration were the highest (74.2% and 80.9%, respectively). The frequency with which a carbapenem antimicrobial drug was administered prior to antimycotics was the highest (41.6%). Blood culture was conducted in 85 patients (68.0%), monitoring culture in 108 (86.4%). Fungi were detected in 10 patients (11.8%) with blood culture and 72 (66.7%) with monitoring culture. The frequency of Candida albicans detection was the highest, 50.0% (5/10), with blood culture. With monitoring culture as well, the frequency of C. albicans detection was the highest, 55.6% (40/72). Alleviation of fever at the completion of registration was recognized in 65.6%. The survival rates at the completion of and at 28 days after the start of data registration of were 78.4% and 69.6%, respectively.


CONCLUSIONS
Many patients in the field of emergency and critical care medicine had risk factors for deep mycosis; 11.8% and 66.7% of our 125 subjects were positive on blood and monitoring cultures, respectively. The majority of the fungi detected belonged to the Candida group, and FLCZ was the most frequently used antimycotic.
Department of Emergency and Critical care medicine, Keio University School of Medicine, Japan.
Hideki
H
Ishikawa
Shigeto
S
Oda
Atsuo
A
Murata
Shuji
S
Shimazaki
Hiroyuki
H
Hirasawa
Naoki
N
Aikawa
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage; D002176:Candida albicans / Q000302:isolation & purification; D003422:Critical Care; D004635:Emergency Medicine; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D000935:Antifungal Agents; D015725:Fluconazole