Background

While fungaemia caused by two or more different species of yeasts (mixed fungaemia, MF) is infrequent, it might be underestimated.

Aims

This study aimed to determine the incidence of MF, clinical characteristics of the patients, and antifungal susceptibility profiles of the isolates with a systematic review of the literature.

Sources

Data sources were PubMed and Scopus.

Study eligibility criteria

Studies reporting ten or more mixed fungaemia episodes.

Content

Study included MF episodes in adults between January 2000 and August 2018 in Hacettepe University Hospitals, Turkey. The isolation, identification and antifungal susceptibility testing (AFST) of the isolates were by standard mycological methods. Patient data were obtained retrospectively. Literature search was performed using relevant keywords according to PRISMA systematic review guidelines. A total of 32 patients with 33 MF episodes were identified. Among all fungaemia episodes, MF incidence was 3.7% (33/883). All patients had one or more underlying disorders among which solid-organ cancer (50.0%, 16/32) was the most common. Overall mortality was 51.5% (17/33). The most preferred antifungal agents for initial treatment were fluconazole (48.5%, 16/33) and echinocandins (39.4%, 13/33). Fluconazole susceptible-dose-dependent (S-DD) or -resistant Candida species were detected in 15 episodes, and an isolate of C. parapsilosis was classified as S-DD by AFST. All Candida isolates were susceptible to echinocandins. Non-candida yeasts with intrinsic resistance/reduced susceptibility to both echinocandins and fluconazole were detected in two episodes. Systematic review of the literature revealed 24 studies that reported more than ten MF episodes. Methodology was variable. Improvement of detection rates was reported when chromogenic agars were used. Most studies underlined detection of isolates with reduced susceptibility.

Implications

Although rare, the MF rate is affected by the detection methods, which have improved in recent years. Fluconazole and echinocandins were used for initial treatment in accordance with the current guideline recommendations; however, isolates non-susceptible to both were detected. Detection of a mixed infection offers an opportunity for optimum treatment.

中文翻译：

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混合性真菌病：来自三级大学医院的18年报告和系统评价。

背景

虽然由两种或多种不同种类的酵母菌（混合真菌病，MF）引起的真菌病很少见，但它可能被低估了。

目的

这项研究的目的是对文献进行系统的回顾，以确定MF的发生率，患者的临床特征以及分离株的抗真菌药性。

资料来源

数据来源是PubMed和Scopus。

研究资格标准

研究报告了十种或更多种混合性真菌病发作。

内容

研究包括2000年1月至2018年8月在土耳其哈塞佩特大学医院的成人MF发作。分离物的分离，鉴定和抗真菌药敏试验（AFST）采用标准的真菌学方法。回顾性获得患者数据。根据PRISMA系统评价指南，使用相关关键字进行文献检索。总共鉴定出32例33 MF发作的患者。在所有真菌血症发作中，MF发生率为3.7％（33/883）。所有患者均患有一种或多种潜在疾病，其中最常见的是实体器官癌（50.0％，16/32）。总死亡率为51.5％（17/33）。初始治疗中最优选的抗真菌药是氟康唑（48.5％，16/33）和棘球and素（39.4％，13/33）。氟康唑易感剂量依赖性（S-DD）或耐药在15次事件中检测到假丝酵母菌种，AFST将副寄生念珠菌分离为S-DD。所有念珠菌分离株均对棘球chin素敏感。在两次发作中检测到​​具有固有抗性/对棘孢菌素和氟康唑的敏感性降低的非念珠菌酵母。对文献的系统回顾显示，有24项研究报告了10多次MF发作。方法是可变的。据报道，使用发色琼脂可提高检测率。大多数研究都强调了对敏感性降低的分离株的检测。

含义

MF率虽然很少见，但受检测方法的影响，近年来，检测方法已有所改进。根据目前的指南建议，氟康唑和棘球and素用于初始治疗。但是，检测到两种都不敏感的分离株。检测混合感染为最佳治疗提供了机会。