Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia

Maiken Cavling Arendrup, Sofia Sulim, Anette Holm, Lene Nielsen, Susanne Dam Nielsen, Jenny Dahl Knudsen, Niels Erik Drenck, Jens Jørgen Christensen, Helle Krogh Johansen

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

Resumé

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.
OriginalsprogEngelsk
TidsskriftClinical Microbiology and Infection
Vol/bind17
Udgave nummers4
Sider (fra-til)S786
ISSN1198-743X
StatusUdgivet - 2011

Fingeraftryk

Intensive Care Units
Vascular Access Devices
Fluconazole
Age Distribution
Hematology
Saccharomyces cerevisiae
Guidelines
Blood Culture

Citer dette

Arendrup, M. C., Sulim, S., Holm, A., Nielsen, L., Nielsen, S. D., Knudsen, J. D., ... Johansen, H. K. (2011). Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia. Clinical Microbiology and Infection, 17(s4), S786.
Arendrup, Maiken Cavling ; Sulim, Sofia ; Holm, Anette ; Nielsen, Lene ; Nielsen, Susanne Dam ; Knudsen, Jenny Dahl ; Drenck, Niels Erik ; Christensen, Jens Jørgen ; Johansen, Helle Krogh. / Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia. I: Clinical Microbiology and Infection. 2011 ; Bind 17, Nr. s4. s. S786.
@article{ccdfb7eb282144b687a4b56f0f3774e9,
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.",
author = "Arendrup, {Maiken Cavling} and Sofia Sulim and Anette Holm and Lene Nielsen and Nielsen, {Susanne Dam} and Knudsen, {Jenny Dahl} and Drenck, {Niels Erik} and Christensen, {Jens J{\o}rgen} and Johansen, {Helle Krogh}",
year = "2011",
language = "English",
volume = "17",
pages = "S786",
journal = "Clinical Microbiology and Infection",
issn = "1198-743X",
publisher = "Elsevier",
number = "s4",

}

Arendrup, MC, Sulim, S, Holm, A, Nielsen, L, Nielsen, SD, Knudsen, JD, Drenck, NE, Christensen, JJ & Johansen, HK 2011, 'Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia', Clinical Microbiology and Infection, bind 17, nr. s4, s. S786.

Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia. / Arendrup, Maiken Cavling; Sulim, Sofia; Holm, Anette; Nielsen, Lene; Nielsen, Susanne Dam; Knudsen, Jenny Dahl; Drenck, Niels Erik; Christensen, Jens Jørgen; Johansen, Helle Krogh.

I: Clinical Microbiology and Infection, Bind 17, Nr. s4, 2011, s. S786.

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review

TY - ABST

T1 - Diagnostic issues, clinical characteristics, and outcomes for patients with fungemia

AU - Arendrup, Maiken Cavling

AU - Sulim, Sofia

AU - Holm, Anette

AU - Nielsen, Lene

AU - Nielsen, Susanne Dam

AU - Knudsen, Jenny Dahl

AU - Drenck, Niels Erik

AU - Christensen, Jens Jørgen

AU - Johansen, Helle Krogh

PY - 2011

Y1 - 2011

N2 - 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.

AB - 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.

M3 - Conference abstract in journal

VL - 17

SP - S786

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

IS - s4

ER -