Fungemia in non-HIV-infected patients: a five-year review

Abstract

Objectives: To investigate the incidence, risk factors, causative fungi, and outcomes of fungemia in adult, non-HIV-infected patients.

Design: We studied 147 episodes of fungemia due to Candida spp and Trichosporon spp in adult patients admitted to a university hospital in Northeast Thailand between 1999 and 2003.

Results: The overall incidence of fungemia was 14.1 per 10,000 hospital admissions. Candida was the most common isolate (138 episodes, 93.9%) with non-albicans Candida accounting for 68.7%. The major non-albicans Candida isolates were Candida parapsilosis and Candida tropicalis. Fungemia caused by Trichosporon accounted for 6.1% of the cases, but their clinical features could not be distinguished from fungemia due to Candida. The overall in-hospital mortality rate was 56.1%. The independent factors related to mortality were high APACHE II score (odds ratio (OR) 1.12 per 1-point increments, 95% confidence interval (CI) 1.03-1.23), assisted ventilation (OR 3.49, 95% CI 1.04-11.64), and neutropenia (OR 7.47, 95% CI 1.25-44.74).

Conclusions: Candidemia, especially that caused by non-albicans Candida, was an important nosocomial infection in this tertiary care hospital in Northeast Thailand. The mortality rate was high, particularly in patients who were critically ill. Rapid diagnosis and early treatment are therefore important challenges for improving clinical outcomes.