The distribution, patient characteristics, therapy and patient outcome in culture positive invasive mold infections in a tertiary hospital in the Free State province, South Africa
Van der Westhuizen, B.
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Introduction Fungi, including molds, are increasingly recognized as important pathogens carrying a high morbidity and mortality in critically ill and immune compromised patients and our understanding of these diseases remain incomplete, largely due to the lack of surveillance data. This study aimed to better quantify the distribution, patient characteristics, risk factors, therapy and treatment outcome in culture positive invasive mold infections at Universitas Academic Hospital in the Free State province, South Africa. Methods All culture positive mold isolates cultured from sterile specimens were identified retrospectively from 1 July 2014 to 30 June 2017. Laboratory and clinical data were reviewed for those that met the inclusion criteria. Results A total of 48 isolates were included in this study. There was a similar distribution between males and females and the mean age was 40.5 years. Aspergillus species were the most commonly isolated mold. The most common risk factors identified were HIV infection with a median CD4 of 88.5 cells/μl followed by hematological conditions. The treatment strategies in our study group were heterogeneous with 73.1% (19/26) of patients treated with antifungal therapy alone, 19.2% (5/26) with surgery alone and 7.7% (2/26) with a combined medical and surgical approach. Many patients received no treatment 45.8% (22/48). The overall mortality was 25% (12/48). Conclusions The diagnosis of invasive mold infections remains a challenge. In the current study, molds were found to cause serious infections, especially in at risk patients. Despite treatment with appropriate antifungal agents, the associated mortality rate was still high. This study contributes to the growing knowledge on the distribution, patient characteristics and outcomes of invasive mold infections, particularly in patients in the Free State, and lays the foundation for further research in the field of invasive mold infections.