title: Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia.
abstract: This study investigated microbiological, clinical, and management issues and outcomes for Danish fungemia patients. Isolates and clinical information were collected at six centers. A total of 334 isolates, 316 episodes, and 305 patients were included, corresponding to 2/3 of the national episodes. Blood culture positivity varied by system, species, and procedure. Thus, cases with concomitant bacteremia were reported less commonly by BacT/Alert than by the Bactec system (9% [11/124 cases] versus 28% [53/192 cases]; P < 0.0001), and cultures with Candida glabrata or those drawn via arterial lines needed longer incubation. Species distribution varied by age, prior antifungal treatment (57% occurrence of C. glabrata, Saccharomyces cerevisiae, or C. krusei in patients with prior antifungal treatment versus 28% occurrence in those without it; P = 0.007), and clinical specialty (61% occurrence of C. glabrata or C. krusei in hematology wards versus 27% occurrence in other wards; P = 0.002). Colonization samples were not predictive for the invasive species in 11/100 cases. Fifty-six percent of the patients had undergone surgery, 51% were intensive care unit (ICU) patients, and 33% had malignant disease. Mortality increased by age (P = 0.009) and varied by species (36% for C. krusei, 25% for C. parapsilosis, and 14% for other Candida species), severity of underlying disease (47% for ICU patients versus 24% for others; P = 0.0001), and choice but not timing of initial therapy (12% versus 48% for patients with C. glabrata infection receiving caspofungin versus fluconazole; P = 0.023). The initial antifungal agent was deemed suboptimal upon species identification in 15% of the cases, which would have been 6.5% if current guidelines had been followed. A large proportion of Danish fungemia patients were severely ill and received suboptimal initial antifungal treatment. Optimization of diagnosis and therapy is possible.
authors.affiliation: Unit of Mycology, 43/117, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, 2300 Copenhagen, Denmark. mad@ssi.dk
authors.forename: Maiken Cavling
authors.initials: MC
authors.lastname: Arendrup
authors.forename: Sofia
authors.initials: S
authors.lastname: Sulim
authors.forename: Anette
authors.initials: A
authors.lastname: Holm
authors.forename: Lene
authors.initials: L
authors.lastname: Nielsen
authors.forename: Susanne Dam
authors.initials: SD
authors.lastname: Nielsen
authors.forename: Jenny Dahl
authors.initials: JD
authors.lastname: Knudsen
authors.forename: Niels Erik
authors.initials: NE
authors.lastname: Drenck
authors.forename: Jens Jørgen
authors.initials: JJ
authors.lastname: Christensen
authors.forename: Helle Krogh
authors.initials: HK
authors.lastname: Johansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D005260:Female; D016469:Fungemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012441:Saccharomyces cerevisiae / Q000302:isolation & purification*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents