[Nosocomial fungal infections, analysis of 149 cases]

Abstract

Objective: To investigate the manifestation, diagnosis, antifungal therapy and outcome of nosocomial fungal infections.

Methods: The clinical data of 149 patients with nosocomial fungal infections admitted in the PUMC hospital from Dec. 1981 to Nov. 2001, 67 males and 82 females with an average age of 52.32 years, including the manifestation, diagnosis, treatment and outcome, were reviewed retrospectively.

Results: 134 out of the 149 patients suffered from deep mycoses. All cases had underlying conditions, including primary pulmonary diseases (n = 29), rheumatic disease (n = 20), hematological disease such as leukemia or lymphoma (n = 18), HIV infection/AIDS (n = 13), major surgery (n = 10), and intracerebral hemorrhage or cerebral infarction (n = 24). The predisposing factors or risk factors for deep mycoses included use of high dose broad-spectrum antibiotics over a long period (n = 37), steroids/cytotoxic chemotherapy (n = 29), immunosuppressant (n = 17), chemotherapy (n = 10), intravenous lines and incubation (n = 36), and tracheotomy or endotracheal intubation (n = 12). The infectious sites were lung, meninges, cerebral parenchyma, blood, etc. in the order of prevalence. Depending on infectious site and type of fungus, the clinical manifestations included fever (63.76%), respiratory symptom such as cough (37.58%), leucocytosis (39.6%), chest X-ray images (24.49%) etc. CNS fungal infection included meningitis, brain abscess, and granuloma. Meningitis due to Cryptococcus resembled that due to Mycobacterium tuberculosis. The main pathogenic fungal species were Candida albicans, C. tropicalis, C. parapsilosis, C. neoformans, and Aspergillus species. Amphotericin B, fluconazole, and flucytosine were used alone or in combination. The overall mortality rate was 29.53% (44/149). Out of the 149 patients 67 were cured, 29 made improvement. The incidence of fungal infection remarkably increased recently with 75 cases appearing in the past 5 years (50.34%).

Conclusion: The incidence of fungal infection is increasing recently which is correlated with use of high dose broad-spectrum antibiotics over a long period, high dose steroids/cytotoxic chemotherapy, immunosuppressant, chemotherapy, and improvement of examination skills, etc. The main pathogens are still Candida albicans and non-albicans Candida species. Early diagnosis is very important.