Relation Between the Predisposing Factors and Fungal Species in the Patients with Fungemia

In recent years, fungi have Played an increasingly important role as pathogens innosocomial infection, and the incidence of nosocomial fungemia appears to be increased as aresult of clinical and therapeutic factors. We investigated the incidence of fungemia and relationbetween the predisposing factors and fungal species to be helpful in the prevention and early diagnosis of nosocomial fungemia.

We reviewed 45 cases of fungemia in Ewha Womans University DongdaemoonHospital from Jan. 1991 to Oct. 1995 to examine the predisposing factors, underlying illness,concomitant bacteremia, morality and outcome by the fungal species.

During recent five years, fungemia was increased in incidence. Candida albicans (C.albicans) was e most common species of fungemia (36%), fo11owed by C. parapsilosis (25%), C.tropicalis (18%), C. glabrata (11%), C. guilliermondii (4%) and the uncommon species were Cryp-tococcus neoformans (2%), Saccharomyces cerevisiae (2%) and Fusarium species (2%). Solid tumors (23%) was the most common underlying disease in the patients with fungemia,fo11owedby trauma (18%), hematologic malignancr (13%), cerebrovascular attack (10%), prematurity (10%)and other nononcologic disease was 26%. C. albicans was commonly associated with nononcologic disease, especially prematurity (100%) and was frequently preceded by parenteral antibiotics (92%), intravenous catheterization (39%) and parenteral hyperalimentation (39%). C.parapsilosis was commonly associated with trauma (57%), cerebrovascular attack (50%) and waspreceded by intravenous catheterization (82%), steroid (73%), parenteral hyperalimentation (45%)and concomitant bacteremia (45%). C. tropicalis occurred most Frequently in hematologic malignancy (60%) and was frequently preceded by neultropenia and chemotherapy. C. glabrata and C.guilliermondii were most commonly associated with solid tumors and was preceded by abdominal surgery and parenteral hyperalimenation in all cases. Other rare fungi were Cryptococcus neoformans, Saccharomyces cerevisiae and Fusarium species which were associated withdiabetes mellitus, systemic lupus erythematosus and aplastic anemia, respectively. Overall mortality of fungemia was 21% and C. parapsilosis (18%) and C. tropicalis(14%) were more favorable outcome than C. glabrata (25%) and C. albicans (23%)

These results suggest that the incidence of fungemia are increased as a result ofvarious predisposing factors and removal of the predisposing factors will be helpful in the prevention of nosocomial fungemia.