Prognostic indicators in fungemia of the surgical patient
E. Tang, G. Tang and T. V. Berne
Department of Surgery, University of Southern California School of Medicine, Los Angeles.
OBJECTIVE: The objective of this study is to identify prognostic factors
affecting mortality in surgical patients with culture-proved 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.
