Fungal sepsis: multisite colonization versus fungemia

Abstract

The indications for therapy and the best treatment regimens for systemic fungal infections are not well defined. The purpose of this study was to evaluate retrospectively patient management and outcome in critically ill patients with multiple sites of fungal colonization and/or fungemia. Medical records of 36 fungemic patients and 76 patients without fungemia who had two or more anatomic sites colonized with fungal organisms were reviewed. There were 53 males and 59 females, with a mean age of 58 years (range 15-86). Eighty-four patients (74%) underwent 238 operations (41% elective, 59% emergent). Gastrointestinal (37%), thoracic (15%), and orthopedic (13%) procedures were most common. Concomitant, nonfungal bacteremia was present in 56 patients (50%). Seventy-one patients (63%) received systemic antifungal therapy. Mortality differences between patients with fungemia (17/36; 47%) and fungus-colonized patients (31/76; 41%) were not statistically significant. Amphotericin B treatment of fungemia reduced mortality overall (26% vs 71%, P < 0.05) and compared with fungemic patients receiving other antifungals (26% vs 50%, P < 0.05). Among fungus-colonized patients, mortality was higher with amphotericin B than without (70% vs 36%, P < 0.05) and was not changed by treatment with other antifungals (37% vs 34%). Increased gastrointestinal operations, wound infections, and intraperitoneal fungi and bacteria in fungus-colonized patients receiving amphotericin B suggest that these patients were the most critically ill. The mortality of multisite fungal colonization is as high as that of fungemia. Only amphotericin B improves survival in fungemia. The best treatment for multisite colonization is not clear from the data.