Antifungal Treatment Delays Responsible For Excess Deaths From Fungal Infection

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Antifungal Treatment Delays Responsible For Excess Deaths From

Fungal Infection: Presented at ICAAC

DG News*

By Gever

http://www.docguide.com/news/content.nsf/news/852571020057CCF68525735

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CHICAGO, IL -- September 21, 2007 -- High mortality rates associated

with systemic fungal infection could be reduced substantially if

antifungal therapy is started sooner than is typically the case now,

researchers said here at the 47th Annual Interscience Conference on

Antimicrobial Agents and Chemotherapy (ICAAC).

Systemic fungal infections, which often lead to septic shock, are

associated with mortality rates much higher than those seen with

bacterial infections.

In a retrospective study, a group led by Anand Kumar, MD, Associate

Professor of Medical Microbiology and Internal Medicine, University

of Manitoba, Winnipeg, Manitoba, Canada, analyzed data on 5,715

patients with presumed septic shock in intensive care units (ICUs)

at 22 hospitals.

In 7.8% of these cases (n = 443), Candida fungi were determined to

be responsible. Dr. Kumar said the interval between the onset of

hypotension in the ICU patients and the initiation of effective

antimicrobial therapy was vastly longer in patients with fungal

infections relative to those with bacterial infections (median 35.2

hours vs 5.5 hours, respectively).

Among patients who received effective therapy within 6 hours of

hypotension onset, the in-hospital survival rate exceeded 60%, with

no marked difference between types of infection. Survival rates for

both fungal and bacterial infection decreased dramatically as

treatment delays grew longer.

Dr. Kumar said the poorer overall survival rates for fungal

infection (52.4% vs 86.5%, respectively) were due primarily to

delayed treatment.

Fungal infection was more common in certain types of conditions.

Septic shock was more likely to have fungal than a bacterial origin

in patients with catheter-associated infections, systemic

disseminated infections, primary bloodstream infections, leukemia

and lymphoma, organ transplant, or metastatic cancer. Bacterial

septic shock more often associated with pneumonia, skin and soft

tissue infection, and chemotherapy.

Dr. Kumas said the patients included in the analysis had infections

that were likely or confirmed. Consequently, the onset of

hypotension should have been a signal that septic shock was underway

and that antimicrobial therapy should be started right away. He also

said it would be reasonable to include antifungal medication as part

of empiric treatment in these patients. Many ICUs routinely include

agents narrowly targeted at uncommon bacteria, so the fact that

Candida yeasts account for only 8% of shock cases is not, by itself,

a reason not to include antifungal coverage, Dr. Kumar said.

He added that many physicians tend not to treat aggressively

patients with fungal septic shock because the high historical death

rate makes treatment appear futile. But, he said, " the reason it has

such horrible mortality is that we don't treat it. "

Dr. Kumar recommended that physicians seek ways to reduce the time

to diagnosis and treatment of fungal infections in patients at risk

for systemic illness.

[Presentation title: The High Mortality of Candida Septic Shock is

Explained by Excessive Delays in Initiation of Antifungal Therapy.

Abstract K-2174]