Fungal infections in adult patients on extracorporeal life support

Abstract

BackgroundPatients on extracorporeal membrane oxygenation (ECMO) are often among the most severely ill in the intensive care unit. They are often receiving broad-spectrum antibiotics; they have multiple entry points for pathogens; and their immune system is impaired by blood circuit interaction. These factors are thought to predispose them to fungal infections. We thus aimed to evaluate the prevalence, risk factors, and prognosis of fungal infections in adults on ECMO.MethodsWe conducted a retrospective cohort study using the Extracorporeal Life Support Organization registry, which compiles data on ECMO use from hundreds of international centers. We included all adult patients from 2006 to 2016 on any mode of ECMO with either a diagnosis of fungal infection or a positive fungal culture.ResultsOur study comprised 2129 adult patients (10.8%) with fungal colonization or infection. Aspergillus involvement (colonization or infection) was present in 272 patients (1.4%), of whom 35.7% survived to hospital discharge. There were 245 patients (1.2%) with Candida invasive bloodstream infection, with 35.9% survival. Risk factors for Aspergillus involvement included solid organ transplant (OR 1.83; p = 0.008), respiratory support (OR 2.75; p < 0.001), and influenza infection (OR 2.48; p < 0.001). Risk factors for candidemia included sepsis (OR 1.60; p = 0.005) and renal replacement therapy (OR 1.55; p = 0.007). In multivariable analysis, Aspergillus involvement (OR 0.40; p < 0.001) and candidemia (OR 0.47; p < 0.001) were both independently associated with decreased survival.ConclusionsThe prevalence of Aspergillus involvement and Candida invasive bloodstream infection were not higher in patients on ECMO than what has been reported in the general intensive care population. Both were independently associated with a reduced survival. Aspergillus involvement was strongly associated with ECMO for respiratory support and influenza.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2023-z) contains supplementary material, which is available to authorized users.

Action mechanisms of probiotics onCandidaspp. and candidiasis prevention: an update

“…Oral candidiasis represents a significant clinical problem, especially in elderly individuals who use prosthetic devices, HIV-positive individuals or patients submitted to head and neck radiotherapy (Chandrasekar 2011;Coronado-Castellote and Jimenez-Soriano 2013;Garcia-Cuesta et al 2014;Zhang et al 2016). According to Cavayas et al (2018), the Candida species are responsible for the third-highest incidence of isolates from bloodstream infections in neutropenic or immunocompromised hospitalized patients from intensive care units (ICUs). Bloodstream infections with Candida species account for 8-15% of hospital-acquired sepsis in the United States (Edmond et al 1999;Wisplinghoff et al 2004).…”

Biomarkers for Point-of-Care Diagnosis of Sepsis

“…Despite the difficulties involved in collecting epidemiological data at national levels, work has been conducted that attempts to estimate the global burden of sepsis for both adult [13] and, more recently, neonatal and paediatric sepsis [14]. Both of these large systematic reviews focused on identifying robust epidemiological studies and performing meta-analysis to provide current best estimates of sepsis.…”

“…Both of these large systematic reviews focused on identifying robust epidemiological studies and performing meta-analysis to provide current best estimates of sepsis. In adults, it was estimated that there are 31.4 million cases of sepsis and 5.3 million deaths due to sepsis per year, based on a global population of 7.2 billion people [13]. In children and neonates, the annual incidence of sepsis was estimated as 1.2 million and 3 million cases respectively, based on the same global population, with combined mortality being between 11% and 19% [14].…”

“…Although estimates were extrapolated to the global population, it is possible that this is not a true reflection of the global burden of sepsis, as the sepsis rates in these countries are unknown. It is recognised that infectious disease rates are higher in these countries [13]; therefore, it could be postulated that the incidence of sepsis may be higher as a consequence. Although sepsis is not recognised as a distinct mortality-causing entity in the statistics compiled by the Global Burden of Disease (GBD) project (as causes of death are attributed to the initial infection [1]), recent work by Rudd and co-workers using GBD data has suggested that in 2017, the number of cases of sepsis globally was 48.9 million, with 11 million deaths as a result [16].…”

“…Fungal infections that cause sepsis are almost always contracted after a patient has been admitted to hospital and, as is the case with viral sepsis, the presentation of fungal sepsis is similar to that of bacterial sepsis [10]. However, fungi can grow rapidly and are associated with high mortality [13]. Opportunistic infection by fungal species presents an increased threat to patients who are already immunosuppressed, or to patients who are already in a critical care environment.…”