Diagnostic Issues, Clinical Characteristics, and Outcomes for Patients with Fungemia
| Autor: | Lene Nielsen, Jens Jørgen Christensen, Helle Krogh Johansen, Niels Erik Drenck, Sofia Sulim, Jenny Dahl Knudsen, Maiken Cavling Arendrup, Susanne Dam Nielsen, Anette Holm |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Antifungal Agents Adolescent Denmark Saccharomyces cerevisiae Mycology law.invention Young Adult chemistry.chemical_compound Pharmacotherapy Risk Factors law Internal medicine medicine Humans Blood culture Child Fungemia Aged Candida Aged 80 and over Candida glabrata biology medicine.diagnostic_test business.industry Infant Newborn Infant Middle Aged bacterial infections and mycoses biology.organism_classification medicine.disease Intensive care unit Surgery Treatment Outcome chemistry Child Preschool Bacteremia Female Caspofungin business Fluconazole medicine.drug |
| Zdroj: | Arendrup, M C, Sulim, S, Holm, A, Nielsen, L, Nielsen, S D, Knudsen, J D, Drenck, N E, Christensen, J J & Johansen, H K 2011, ' Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia ', Clinical Microbiology and Infection, vol. 17, no. s4, pp. S786 . Arendrup, M C, Sulim, S, Holm, A, Nielsen, L, Nielsen, S D, Knudsen, J D, Drenck, N E, Christensen, J J & Johansen, H K 2011, ' Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia ', Journal of Clinical Microbiology, vol. 49, no. 9, pp. 3300-8 . https://doi.org/10.1128/JCM.00179-11 |
| ISSN: | 1098-660X 0095-1137 |
| DOI: | 10.1128/jcm.00179-11 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|