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Prognostic Indicators in Fungemia of the Surgical Patient

Prognostic Indicators in Fungemia of the Surgical Patient Abstract Objective: The objective of this study is to identify prognostic factors affecting mortality in surgical patients with cultureproved fungemia and to examine how amphotericin B affects mortality after controlling for these factors. Design: The study is based on a retrospective logistic regression analysis of general surgical patients with blood cultures positive for fungi. We analyzed the patients' ages; whether they received triple antibiotics, had diabetes, had malignant neoplasia, received steroids, had concomitant bacteremia, or took antibiotics for greater than 7 days; and total dose of amphotericin B. Setting: The study was carried out at a university-based county hospital. Patients: Analysis of microbiology records for blood cultures that were positive for fungi from November 1987 to January 1992 revealed 63 general surgical patients. Patients with burns and those undergoing organ transplantation were excluded. Forty charts were complete and available for review. Main Outcome: Death was the outcome variable studied. Results: Stepwise logistic regression analysis of death revealed age to be a risk factor for mortality. Treatment with at least 210 mg of amphotericin B was associated with relative risk of death of 0.055. Conclusion: Amphotericin B is effective even at low doses at decreasing the mortality in surgical patients with fungemia. On the other hand, increasing age is associated with an increased risk of mortality. Found not to be associated were concomitant bacteremia, concurrent triple antibiotic therapy, malignant neoplasia, and steroid use.(Arch Surg. 1993;128:759-763) References 1. Nolla-Salas JC, Leon C, Torres-Rodriguez JM, Martin E, Sitges-Serra A. Treatment of candidemia in critically ill surgical patients with intravenous fluconazole . Clin Infect Dis . 1992;14:952-954.Crossref 2. Solomkin JS, Flohr AM, Simmons RL. Indications for therapy for fungemia in postoperative patients . Arch Surg . 1982;117:1272-1275.Crossref 3. Dyess DL, Garrison RN, Fry DE. Candida sepsis . Arch Surg . 1985;120:345-348.Crossref 4. Burchard KW, Minor LB, Slotman GJ, Gann DS. Fungal sepsis in surgical patients . Arch Surg . 1983;118:217-221.Crossref 5. Komshian SV, Uwaydah AK, Sobel JD, Crane LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome . Rev Infect Dis . 1989; 11:379-390.Crossref 6. Solomkin JS, Flohr AB, Quie PG, Simmons RL. The role of Candida in intraperitoneal infections . Surgery . 1980;88:524-530. 7. Harvey RL, Myers JP. Nosocomial fungemia in a large community teaching hospital . Arch Intern Med . 1987;147:2117-2120.Crossref 8. Bross J, Talbot GH, Maisin G, Hurwitz S, Strom BL. Risk factors for nosocomial candidemia: a case-control study in adults without leukemia . Am J Med . 1989;87:614-620.Crossref 9. Stone HH, Kolb LD, Currie CA, Geheber CE, Cuzzell JZ. Candida sepsis: pathogenesis and principles of treatment . Ann Surg . 1974;179:697-711.Crossref 10. Katz S, Merkel GJ, Folkening WJ, Ropsenthal RS, Grosfeld JL. Impaired clearance and organ localization of Candida albicans in obstructive jaundice . J Pediatr Surg . 1991;26:904-907.Crossref 11. Meunier-Carpentier F, Kiehn TE, Armstrong D. Fungemia in the immunocompromised host . Am J Med . 1981;71:363-370.Crossref 12. Spebar MJ, Pruitt BA. Candidiasis in the burned patient . J Trauma . 1981;21: 237-239.Crossref 13. Verghese A, Prabhu K, Diamond RD, Sugar A. Synchronous bacterial and fungal septicemia: a marker for the critically ill surgical patient . Am Surg . 1988; 54:276-283. 14. Bryce EA, Roberts FJ, Sekhon AS, Coldman AJ. Yeast in blood cultures . Diagn Microbiol Infect Dis . 1992;15:233-237.Crossref 15. Medoff G. Controversial areas in antifungal chemotherapy: short-course and combination therapy with amphotericin B . Rev Infect Dis . 1987;9:403-407.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Prognostic Indicators in Fungemia of the Surgical Patient

Archives of Surgery , Volume 128 (7) – Jul 1, 1993

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1993.01420190049007
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: The objective of this study is to identify prognostic factors affecting mortality in surgical patients with cultureproved fungemia and to examine how amphotericin B affects mortality after controlling for these factors. Design: The study is based on a retrospective logistic regression analysis of general surgical patients with blood cultures positive for fungi. We analyzed the patients' ages; whether they received triple antibiotics, had diabetes, had malignant neoplasia, received steroids, had concomitant bacteremia, or took antibiotics for greater than 7 days; and total dose of amphotericin B. Setting: The study was carried out at a university-based county hospital. Patients: Analysis of microbiology records for blood cultures that were positive for fungi from November 1987 to January 1992 revealed 63 general surgical patients. Patients with burns and those undergoing organ transplantation were excluded. Forty charts were complete and available for review. Main Outcome: Death was the outcome variable studied. Results: Stepwise logistic regression analysis of death revealed age to be a risk factor for mortality. Treatment with at least 210 mg of amphotericin B was associated with relative risk of death of 0.055. Conclusion: Amphotericin B is effective even at low doses at decreasing the mortality in surgical patients with fungemia. On the other hand, increasing age is associated with an increased risk of mortality. Found not to be associated were concomitant bacteremia, concurrent triple antibiotic therapy, malignant neoplasia, and steroid use.(Arch Surg. 1993;128:759-763) References 1. Nolla-Salas JC, Leon C, Torres-Rodriguez JM, Martin E, Sitges-Serra A. Treatment of candidemia in critically ill surgical patients with intravenous fluconazole . Clin Infect Dis . 1992;14:952-954.Crossref 2. Solomkin JS, Flohr AM, Simmons RL. Indications for therapy for fungemia in postoperative patients . Arch Surg . 1982;117:1272-1275.Crossref 3. Dyess DL, Garrison RN, Fry DE. Candida sepsis . Arch Surg . 1985;120:345-348.Crossref 4. Burchard KW, Minor LB, Slotman GJ, Gann DS. Fungal sepsis in surgical patients . Arch Surg . 1983;118:217-221.Crossref 5. Komshian SV, Uwaydah AK, Sobel JD, Crane LR. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome . Rev Infect Dis . 1989; 11:379-390.Crossref 6. Solomkin JS, Flohr AB, Quie PG, Simmons RL. The role of Candida in intraperitoneal infections . Surgery . 1980;88:524-530. 7. Harvey RL, Myers JP. Nosocomial fungemia in a large community teaching hospital . Arch Intern Med . 1987;147:2117-2120.Crossref 8. Bross J, Talbot GH, Maisin G, Hurwitz S, Strom BL. Risk factors for nosocomial candidemia: a case-control study in adults without leukemia . Am J Med . 1989;87:614-620.Crossref 9. Stone HH, Kolb LD, Currie CA, Geheber CE, Cuzzell JZ. Candida sepsis: pathogenesis and principles of treatment . Ann Surg . 1974;179:697-711.Crossref 10. Katz S, Merkel GJ, Folkening WJ, Ropsenthal RS, Grosfeld JL. Impaired clearance and organ localization of Candida albicans in obstructive jaundice . J Pediatr Surg . 1991;26:904-907.Crossref 11. Meunier-Carpentier F, Kiehn TE, Armstrong D. Fungemia in the immunocompromised host . Am J Med . 1981;71:363-370.Crossref 12. Spebar MJ, Pruitt BA. Candidiasis in the burned patient . J Trauma . 1981;21: 237-239.Crossref 13. Verghese A, Prabhu K, Diamond RD, Sugar A. Synchronous bacterial and fungal septicemia: a marker for the critically ill surgical patient . Am Surg . 1988; 54:276-283. 14. Bryce EA, Roberts FJ, Sekhon AS, Coldman AJ. Yeast in blood cultures . Diagn Microbiol Infect Dis . 1992;15:233-237.Crossref 15. Medoff G. Controversial areas in antifungal chemotherapy: short-course and combination therapy with amphotericin B . Rev Infect Dis . 1987;9:403-407.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Jul 1, 1993

References