Severe fungal infections in intensive therapy.
BACKGROUND
Identification of pathogens in severe fungal infections, by positive cultures, is usually difficult, delays appropriate therapy, and impairs treatment. Despite progress in biologic sciences, the diagnosis of candidiasis still poses a challenge. Early symptoms are not specific, and cultures are usually negative. Molecular methods are rarely used in clinical practice. Common empiric therapy of suspected fungal infection is based on examination, history, and analysis of risk factors. The aim of the study was to analyse fungal infections in ITU and to find factors which may help in their recognition.


METHODS
In this retrospective study, the medical histories of ITU patients were analysed. Patients were divided into two groups: I - suspected and II - confirmed, fungal infections. The factors considered were: age, gender, suspected source of fungal infection, co-existing bacterial infection, Candida Score, laboratory tests taken on the day of fungal infection diagnosis (leukocyte count, platelets, and CRP), duration of hospitalisation, declarations of infection from departments, and results of treatment.


RESULTS
Statistically significant differences between the groups were found in Candida Scores, duration of hospitalisation and departments of infection. The Candida Scores were higher among those patients in whom infections were already suspected. In this group, the duration of hospitalization was shorter, and infections frequently developed during hospitalisation in the ITU.


CONCLUSIONS
The analysis of infections and Candida Scores helped to initiate prompt antifungal therapy and to reduce the duration of hospitalisation. Infection markers that were routinely used in the ITU were not specific, did not allow identification of patients with fungal infection.
Department of Anaesthesiology and Intensive Therapy, Medical University of Silesia in Katowice, ul. Ziołowa 45/47, 40-635 Katowice-Ochojec, Poland. oait@gcm.pl
Danuta
D
Gierek
Józefa
J
Dąbek
Małgorzata
M
Kuczera
Małgorzata
M
Marmaj
Grzegorz
G
Kluczewski
Lukasz
L
Krzych
D000328:Adult; D000367:Age Factors; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D002097:C-Reactive Protein / Q000378:metabolism; D002176:Candida albicans; D002177:Candidiasis / Q000188:drug therapy; D003422:Critical Care; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D012141:Respiratory Tract Infections / Q000382:microbiology / Q000628:therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology; D012737:Sex Factors
D000935:Antifungal Agents; D015725:Fluconazole; D002097:C-Reactive Protein