620. Yeasts Fungemia in Kyoto University Hospital, Japan: The Impact of Non- Candida Yeasts
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:

Yeasts fungemia has greatly increased in recent years. Early identification of the causative yeast species is very important, because antifungal susceptibility profiles may differ among species. The aims of this study are to evaluate the incidence and mortality of yeasts fungemia and to identify the risk factors that differentiate non-Candida yeasts (NCY) fungemia from candidemia.

Methods:

We retrospectively studied yeasts fungemia in Kyoto University Hospital from 2004 to 2009. We investigated the incidence, mortality, prognostic factors and risk factors of fungemia due to all yeasts, Candida spp. and NCY.

Results:

125 yeasts were identified by positive blood culture in 110 patients. 116 episodes (92.8%) were nosocomial infections. Candida spp. were the most common isolate (114 episodes, 91.2%) with 49 C. albicans (39.2%) and 65 non-albicans Candida spp. (52.0%). The major non-albicans Candida spp. isolates were C. parapsilosis (30 episodes, 24.0%) and C. glabrata (16 episodes, 12.8%). NCY were isolated in 11 episodes (8.8%), including 6 Cryptococcus neoformans (4.8%), 4 Trichosporon asahii (3.2%) and 1 Pichia ohmeri (0.8%). There was no trend towards increased the rate of NCY over this study period (p = 0.66). The overall 30-day mortality was 23.2%. NCY fungemia had high mortality (20.2% vs 54.5%, p = 0.01). Independent risk factors for 30-day mortality of yeasts fungemia included high age (OR 1.03, 95% confidence interval (CI) 1.00-1.06) and high SOFA score (OR 1.16, 95%CI 1.07-1.25). Presence of fungal colonization (p = 0.03), corticosteroid use (p = 0.01), chronic kidney disease (CKD, p < 0.01), hemodialysis (HD, p < 0.01) and prolonged hospitalization (p = 0.02) were significantly more common in NCY than Candida spp. Solid malignancy was less common in NCY (p < 0.01).

Conclusion:

Although candidemia was common in yeasts fungemia, we should pay more attention to NCY because of the high mortality, especially among aged critically ill patients with fungal colonization, corticosteroid use, CKD, HD and prolonged hospitalization and without solid malignancy.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Masaki Yamamoto, MD , Kyoto University Hospital, Kyoto, Japan
Shunji Takakura, MD, PhD , Kyoto University Hospital, Kyoto, Japan
Akiko Uehara, MD , Kyoto University Hospital, Kyoto, Japan
Keiko Yasuma, MD , Kyoto University Hospital, Kyoto, Japan
Keisuke Yoshimoto, MD , Kyoto University Hospital, Kyoto, Japan
Yasufumi Matsumura, MD , Kyoto University Hospital, Kyoto, Japan
Aki Matsushima, MD, PhD , Kyoto University Hospital, Kyoto, Japan
Miki Nagao, MD, PhD , Kyoto University Hospital, Kyoto, Japan
Yutaka Ito, MD, PhD , Respiratory Medicine, Kyoto University, Kyoto, Japan
Satoshi Ichiyama, MD, PhD , Kyoto University Hospital, Kyoto, Japan

Disclosures:

M. Yamamoto, None

S. Takakura, None

A. Uehara, None

K. Yasuma, None

K. Yoshimoto, None

Y. Matsumura, None

A. Matsushima, None

M. Nagao, None

Y. Ito, None

S. Ichiyama, None

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