What are the risk factors for Fungemia (Fungal infection of the blood)?

From the Guidelines

Fungemia is most commonly associated with risk factors such as prolonged neutropenia, recent broad-spectrum antibiotic use, central venous catheter placement, total parenteral nutrition, immunosuppressive therapy, and prolonged ICU stays, as highlighted in the most recent guidelines 1.

Key Risk Factors

The primary risk factors for fungemia include:

• Prolonged neutropenia, which is a significant risk factor, especially in patients with hematologic malignancies or those undergoing chemotherapy 1
• Recent broad-spectrum antibiotic use, which can disrupt the normal flora and increase the risk of fungal infections 1
• Central venous catheter placement, which can provide a portal of entry for fungi 1
• Total parenteral nutrition, which can increase the risk of fungal infections, particularly in patients with compromised immune systems 1
• Immunosuppressive therapy, which can increase the risk of fungal infections by suppressing the immune system 1
• Prolonged ICU stays, which can increase the risk of fungal infections due to the use of invasive devices and broad-spectrum antibiotics 1

Patient Populations at Risk

Patients with certain underlying conditions are at higher risk of developing fungemia, including:

• Hematologic malignancies, such as acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) 1
• Solid organ or stem cell transplants, which can increase the risk of fungal infections due to immunosuppression 1
• Major abdominal surgery, severe burns, or premature birth, which can increase the risk of fungal infections due to compromised immune systems and invasive devices 1

Importance of Early Recognition

Healthcare providers should maintain a high index of suspicion for fungemia in patients with persistent fever despite antibiotic therapy, particularly when multiple risk factors are present. Early recognition of these risk factors can facilitate prompt initiation of antifungal therapy, which is crucial for improving outcomes in these vulnerable populations 1.

From the Research

Risk Factors for Fungemia

• Immunocompromised patients are at high risk of developing fungemia, including those with malignancy, chemotherapy, transplantation, acquired immunodeficiency syndrome, and usage of immunosuppressant drugs 2
• Established risk factors for invasive fungal infections include previous fungal infection, neutropenia exceeding 10 days, older age, active cancer, corticosteroid therapy, administration of broad spectrum antibiotics, allogeneic HSCT, central venous catheter, and organ dysfunction 3
• Defects in neutrophil function and neutropenia predispose to disseminated Candida, Aspergillus, and Mucoraceae infections, while altered T-lymphocyte mononuclear phagocyte function predisposes to infection with C. neoformans, Histoplasma, and Coccidioides 4
• Pulmonary complications, including fungal infections, are the most common cause of morbidity and mortality in immunocompromised patients, who lack basic mechanisms of cellular defense 5

Patient Populations at Risk

• Cancer patients receiving myelotoxic chemotherapy are at high risk of developing invasive fungal infections 3
• Organ transplant recipients, particularly those with allogeneic HSCT, are at high risk of developing invasive fungal infections 3, 5
• Patients with acquired immunodeficiency syndrome are at high risk of developing invasive fungal infections 2, 4

Fungal Pathogens

• Aspergillus species, mucormycetes, Cryptococcus species, and Candida species are common causes of invasive fungal infections in immunocompromised patients 2, 5, 4
• Candida species are a common cause of disseminated candidiasis, a rare but serious fungal infection 5, 4