Data analysis of patients with positive mould or dimorphic fungal cultures from sterile sites

Abstract

Background: Moulds and dimorphic fungi are increasingly recognised as pathogens carrying high morbidity and mortality in critically ill and immune-compromised patients. The lack of surveillance data limits our understanding of these infections.

Objectives: To determine the distribution, patient characteristics, risk factors, therapy and treatment outcome in patients with positive mould or dimorphic fungal cultures from sterile sites at a tertiary hospital in central South Africa.

Method: All moulds or dimorphic fungi cultured from sterile specimens from 1 July 2014 to 30 June 2017 were identified retrospectively. Laboratory and clinical records were reviewed. Information collected included gender and age, type of specimen collected for investigation, specific fungi isolated, underlying conditions, other contributing risk factors, treatment and outcome of the patients.

Results: Forty-eight patient records were analysed. Male and female patients were equally distributed. The mean age was 40.5 years (range 7–78 years). Aspergillus spp. were most commonly isolated. The most common underlying condition was HIV infection, followed by haematological conditions. Twenty-six (54.2%) patients received treatment involving antifungal therapy alone (n = 19; 73.1%), surgery alone (n = 5; 19.2%) or a combined medical and surgical approach (n = 2; 7.7%). Twenty-two (45.8%) patients received no treatment. The overall mortality rate was 25.0% (n = 12).

Conclusion: The diagnosis of fungal infections remains challenging. In the current study, moulds and dimorphic fungi were isolated from at-risk patients’ specimens. Despite treatment with appropriate antifungal agents, the associated mortality rate was high.

Contribution: This study contributes to the growing body of knowledge on these potentially life-threatening infections.