Treatment of patients with fungemia is predicated on the species of fungus cultured as well as the clinical setting. However, the literature is sparse in regard to the distribution of fungal species as fungemia is a clinically rare entity. Total parenteral nutrition (TPN) is known to be a well-established risk factor for development of fungal blood-stream infection. We hypothesize that usage of TPN changes the species distribution.
We performed a retrospective chart-review of patients admitted to a 350-bed community hospital located in Brooklyn, NY. Using a microbiologic database, we found 57 patients with fungemia. We collected data on the number of positive cultures, species of fungi, antifungal treatment, and usage of TPN. In addition, we also collected information on patient demographics and outcome.
We analyzed the data on 57 patients, 32 males and 25 females. Gender had no correlation with survival. The average age of our population was 64.5 years. 23 patients expired, resulting in a 40.3% mortality rate. A univariate analysis revealed that choice of antifungal therapy had no impact on survival. The most common causative organisms in patients not receiving TPN were Candida tropicalis (41.6%) and Candida albicans (20.8%). The most common causative organisms in patients receiving TPN were Candida albicans (63.6%) and Candida tropicalis (15.2%). Species of fungi had no impact on survival.
Total parenteral nutrition changes the species distribution in patients with fungemia. Patients not receiving TPN were more likely to develop C. Tropicalis, while patients receiving TPN were more likely to develop C. Albicans. This is significant because non-albicans Candida species may be more resistant to fluconazole. Consideration of treatment with higher doses of fluconazole or usage of an alternate antifungal may be warranted.
Individual hospitals should consider monitoring Candida species distribution on a regular basis.
Amy Pate, No Financial Disclosure Information; No Product/Research Disclosure Information