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Emerging Invasive Fungal Infections: Clinical Features and Controversies in Diagnosis and Treatment Processes

Authors Zhang H, Zhu A

Received 8 November 2019

Accepted for publication 30 January 2020

Published 20 February 2020 Volume 2020:13 Pages 607—615


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Suresh Antony

Hongliang Zhang,1 Aiqun Zhu1,2

1Emergency Department, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, People’s Republic of China; 2Department of Nursing, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, People’s Republic of China

Correspondence: Aiqun Zhu
Department of Nursing, The Second Xiangya Hospital of Central South University, No. 139 Renming Middle Road, Changsha, Hunan 410011, People’s Republic of China
Tel +86 731 8529 2120
Fax +86 731 8223 3525

Background: The diagnosis and treatment of invasive fungal infection (IFI) are still challenging due to its complexity and non-specificity. This study was aimed to investigate the clinical features, diagnosis process, and outcomes of patients with emerging IFIs.
Methods: A retrospective review of emerging IFIs in adult patients at a university hospital in China was conducted; diagnoses were based on the criteria of EORTC/MSG 2008.
Results: 145 IFI patients (pulmonary, intestinal and urinary) were enrolled in this study, including 80 proven (55.2%), 59 probable (40.7%), or 6 possible IFIs (4.1%). Among the 126 pulmonary IFIs, the positivity rate for sputum microscopy, sputum culture, and 1.3-ß-D-glucan (BG) test was 54.0%, 44.4%, and 37.3%, respectively. Among the 19 intestinal and urinary IFIs, routine examination of stool or urine and their culture were the main methods of detection. Positive results of 75 detected fungal strains from the samples showed that 30 cases were complicated with one or more bacterial infections. The average length of hospital stay of IFI patients was 14.0 (10.0, 20.0) days. The time from admission to antifungal therapy initiation (P< 0.001), liver cirrhosis (P< 0.001), hematological tumor (P< 0.001), coinfection (P=0.019) and immune diseases (P=0.025) were independent predictors of prolonged hospitalization.
Conclusion: Delayed time was the primary predictor of prolonged hospitalization. This prediction is suggested to improve IFI diagnostic and therapeutic process of IFI to promote prognosis.

Keywords: invasive fungal infections, clinical features, microbiological results, risk factors, hospitalization

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