Polyfungemia at a Tertiary Care Medical Center 1992-2001: A Decade of Experience.



Background: Candida bloodstream infections (BSI) comprise the 4th leading cause of nosocomial BSI among hospitalized patients in the US, associated with an attributable mortality of 35-50%. There are no reports to date describing the features and outcomes of patients who have >1 yeast pathogen isolated simultaneously in the blood. Methods: We performed a retrospective review of microbiology and medical records at Duke University Medical Center, to identify hospitalized patients who had >1 species of Candida or Cryptococcus isolated in >or=1 blood culture within 24 h during 1992-2001. Results: A total of 20 cases of polyfungemia were identified among 12 males and 8 females, with a mean age of 55.2 yrs. 2 were children (1 and 2 yrs of age) and 18 were adults. Underlying conditions included (# cases): diabetes mellitus (1), leukemia (5), solid tumors (7), recent BMT (2), cirrhosis (1), cholangitis (2), peritonitis (1), chemotherapy within last 3 mos (7), SLE (1), neutropenia (5), and abdominal surgery within last 30 days (5). 12/20 patients presented with fever 38.5°C at the time the blood culture was drawn. 7 patients had BSI with C. albicans/C. glabrata, while 3 had C. krusei/C. glabrata, 3 C. albicans/C. tropicalis, 2 each C. albicans/ C. parapsilosis and C. glabrata/C. tropicalis, and one each: C. lusitaniae/C. parapsilosis, C. albicans/C.krusei, C. glabrata/Cryptococcus neoformans. 9 patients were treated with fluconazole (FLU); of these 3 switched to amphotericin B (AB) and 1 to lipid amphotericin B (L-AB). 9 received AB, and one switched to L-AB. 1 received combination of FLU + AB, and 1 patient died before treatment could begin. Overall mortality following initial + blood culture was 6/20 at 7d, 12/20 at 30d, 15/20 at 3 mos. Conclusions: Polyfungemia is an uncommon, but serious manifestation of invasive candidiasis, associated with a high mortality.

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42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 42nd