July 1993

Prognostic Indicators in Fungemia of the Surgical Patient

Author Affiliations

From the Department of Surgery, University of Southern California School of Medicine, Los Angeles.

Arch Surg. 1993;128(7):759-763. doi:10.1001/archsurg.1993.01420190049007

Objective:  The objective of this study is to identify prognostic factors affecting mortality in surgical patients with cultureproved 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.(Arch Surg. 1993;128:759-763)