重型肝炎并发医院内真菌感染168例临床分析

目的:探讨重型肝炎患者医院内真菌感染的易感因素及防治措施.方法:对1996年6月至2006年6月我院收治的重型肝炎患者中发生医院内真菌感染的病例进行回顾性分析.结果:重型肝炎发生医院内真菌感染以白色念珠菌为主(52.75%),其次为热带念珠菌(16.06%).感染部位以肺部感染(44.83%)、口腔感染(25.62%)、咽部感染(10.34%)为主,其次为消化道感染(8.37%)、腹腔感染(6.90%)和泌尿道感染(3.94%).结论:重型肝炎发生医院内真菌感染病死率高,以白色念珠菌为重要病原菌.     

系统性红斑狼疮死亡患者感染部位和病原菌分析

目的 了解近年来系统性红斑狼疮(SLE)感染死亡患者的感染部位和感染病原菌.方法 回顾分析1986年1月至2011年5月北京协和医院SLE住院死亡病例资料.结果 1986年1月至2011年5月SLE住院死亡患者共252例,其中感染为主要死因的患者共97例,非感染原因为主要死因的患者共155例,感染在同期死亡患者中的比例逐渐上升.1986-1990年、1991-1995年、1996-2000年、2001-2005年和2006-2011年,感染死亡患者占同期死亡患者的比例分别为25.7％,24.1％,31.6％,34.9％和60.3％.在因感染死亡的患者中,肺部感染是主要的感染部位,共63例,占感染死亡患者的65％;回顾2006年1月至2011年5年SLE患者肺部感染患者,其中31例患者的病原菌明确,其中单一病原菌感染共14例,占45％,混合感染共17例,占55％.在单一病原菌感染死亡的患者中,最常见的病原菌是真菌感染,共9例,其中耶氏肺孢子菌肺炎4例,烟曲霉感染2例,镰刀菌属1例,热带念珠菌1例,隐球菌1例;普通细菌感染3例,其中耐甲氧西林金黄色葡萄球菌2例,肺炎克雷伯杆菌1例;死于肺结核2例.在混合感染死亡的患者中,混合细菌感染最常见,共14例,其中常见的混合细菌感染依次为鲍曼不动杆菌、大肠埃希菌、肠球菌、肺炎克雷伯杆菌、绿脓杆菌和阴沟肠杆菌,分别为6例、3例、2例、2例、2例和1例;混合真菌感染的患者共11例,在混合真菌感染的患者中烟曲霉菌6例,热带念珠菌3例,耶氏肺孢子菌3例,黄曲霉2例,土曲霉1例,白色念珠菌2例,光滑念珠菌1例,克柔念珠菌1例;除普通细菌和真菌以外,巨细胞病毒感染也是混合感染中常见的病原菌,共5例.结论 感染已成为SLE的最主要死因;肺部感染是最常见的感染部位,混合感染常见,烟曲霉菌、耶氏肺孢子菌、鲍曼不动杆菌和巨细胞病毒感染是以感染为主要死因患者的常见病原体.     

普外科病房深部念珠菌感染标本73例分析

目的:探讨普外科病房深部真菌感染的危险因素及预防措施.方法:回顾分析普外科病房2004-01/2005-12,送检念珠菌阳性的73例患者,分析其临床资料.结果:73例患者各种标本共培养出122株念珠菌,白色念珠菌感染率最高,为45%(55/122),其次为光滑念珠茵40%(49/122)和热带念珠菌7%(8/122).73例患者念珠茵感染排在前5位的疾病依次是胃肠道恶性肿瘤、重症急性胰腺炎、非外伤性消化道穿孔、肝胆胰恶性肿瘤、腹部外伤合并肠穿孔;合并念珠菌感染病死率排在前4位的是非外伤性消化道穿孔、胃肠道恶性肿瘤、急性梗阻性胆管炎和重症急性胰腺炎.其中死亡18例,病死率为25%,除外乳腺癌,其他各疾病病死率均明显高于单纯不合并真菌感染的病种.结论:消化道手术、消化道漏、胃肠道真菌寄殖、广谱抗生素使用、高龄是普外科患者继发真菌感染的重要原因,及时合理的消化道手术、避免消化道漏、无菌操作、保护肠屏障功能是预防普外科病房深部真菌感染的重要措施.     

不同真菌感染对肝衰竭患者病情及预后的影响

目的研究不同真菌感染对肝衰竭患者病情及预后的影响。方法总结肝衰竭合并不同真菌感染患者的临床资料,分析后者对患者病情和转归的影响。结果在资料完整的200例患者中,亚急性肝衰竭3例,慢加急性肝衰竭92例,慢性肝衰竭105例。其中浅部真菌感染39例,侵袭性念珠菌感染89例,侵袭性曲霉菌感染72例。感染前三组患者的终末期肝病模型（MELD）评分分别为25.3±6.0、25.1±6.4和26.2±6.2（P〉0.05）,感染后则分别为25.8±8.7、28.7±9.8和32.9±7.7（P〈0.05）。MELD评分分别增加0.46、3.66和6.75,感染后三组间MELD评分比较,有显著性统计学差异（P=0.000）。浅部真菌感染出院时生存18例（46.1%）,死亡21例（53.9%）,侵袭性念珠菌感染生存34例（38.2%）,死亡55例（61.8%）,侵袭性曲霉菌感染生存11例（15.3%）,死亡61例（84.7%）,三组间病死率比较,差异显著（P〈0.05）。结论侵袭性曲霉菌感染对肝衰竭患者病情恶化的影响最明显,其次是侵袭性念珠菌感染,浅部真菌感染影响较小。     

肝衰竭合并曲霉菌感染的临床特征分析

目的 了解肝衰竭合并曲霉菌感染的临床特征.方法 收集我院1985年1月-2006年6月所有合并真菌感染的肝衰竭患者507例,以合并曲霉菌感染的肝衰竭患者104例为主要分析对象.两组间数据的比较用配对t检验,率的比较用χ2检验. 结果 507例肝衰竭合并真菌感染患者中,曲霉菌感染104例(20.5%).抗真菌治疗的有效率和基础疾病的治愈好转率,曲霉菌感染患者分别为36.5%和26.0%,非曲霉菌感染患者分别为57.8%和36.7%,P=0.000和P=0.049.共分离出曲霉菌108株,烟曲霉菌最为多见,共53株(49.1%),肺脏为曲霉菌主要感染部位90例次(63.8%),感染后临床表现常不典型.在抗真菌治疗有效的患者,肝功能呈好转趋势. 结论肝衰竭合并曲霉菌感染的诊断、治疗困难.对于临床上怀疑有曲霉菌感染的肝衰竭患者,早期积极治疗有助于患者恢复.     

肺结核二重真菌感染回顾性调查分析

目的调查肺结核二重真菌感染病例,为院内抗真菌感染提供参考。方法通过我院2007年医院感染病例登记表,观察住院治疗的肺结核患者,在治疗期间发生深部真菌感染的情况并加以分析。结果确诊为医院内真菌感染51例,其中念珠菌感染占80．39％,曲霉菌感染9．8％,酵母样菌9．8％。大于60岁的患者占62．7％（32／51）。感染部位以肺部为主,肺结核二重真菌感染与联合使用抗生素、患者年龄、基础病、抗痨时间、抗痨方案有关。结论对于肺结核患者,如是老年并伴有严重基础疾病、抗痨联合广谱抗生素治疗时,经验性抗真菌治疗,可减少院内真菌感染。     

慢性阻塞性肺疾病急性加重期合并侵袭性肺曲霉菌病的临床分析

目的 探讨慢性阻塞性肺疾病急性加重期合并侵袭性肺曲霉菌病的临床特点及其危险因素.方法 结合文献回顾分析2006年1月至2008年6月我院收治的慢性阻塞性肺疾病急性加重期患者合并侵袭性肺曲霉菌病感染的临床资料.结果 肺部真菌感染呵能是慢性阻塞性肺疾病患者病情急剧恶化的原因之一.慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的病死率高.肺曲霉菌感染临床表现和影像学缺乏特异性;广谱抗生素和激素的应用、高龄、营养不良等因素是导致肺曲霉菌感染的主要因素.结论 慢性阻塞性肺疾病合并侵袭性肺曲霉菌病缺乏特异性;减少危险因素,及时、合理应用抗真菌药物,做到早期诊断和早期治疗是改善预后的有效方法.     

重型肝炎及活动性失代偿期肝硬化并发霉菌感染的临床特征分析

目的研究重型肝炎及活动性失代偿期肝硬化患者并发霉菌感染的临床特点。方法对79例重型肝炎及活动性失代偿期肝硬化并发霉菌感染患者进行研究,并以221例重型肝炎及活动性失代偿期肝硬化并发白色念珠菌感染患者作为对照,进行统计分析。结果79例重型肝炎及活动性失代偿期肝硬化合并霉菌感染患者中,医院感染72例（91．1％）,院外感染7例（8．9％）。临床诊断急性、亚急性重型肝炎2例,慢性重型肝炎53例,活动性失代偿期肝硬化24例。经治疗好转18例（22．78％）,无效25例（31．65％）,死亡36例（45．57％）。在霉菌感染发生前,有47例临床诊断细菌感染,并分离出G-杆菌18株（60．0％）、G^＋菌8株（26．67％）。感染部位以腹腔居多,其次是肺、血液等。分别有65例和44例患者曾使用抗生素及激素。霉菌感染以曲霉菌为主,感染部位多见于肺部（64．65％）,予抗真菌药物后有效24例（30．38％）,无效55例（69．62％）。结论重型肝炎及活动性失代偿期肝硬化并发霉菌感染患者以医院感染为主,抗霉菌治疗疗效差,病死率高。     

影响老年危重病念珠菌血症患者预后的多因素分析

目的 探讨重症监护病房(ICU)内老年院内念珠菌血症患者预后的影响因素.方法 收集2001-2008年我院75例院内获得性念珠菌血症老年患者的临床资料,根据预后分为死亡组和生存组,运用多因素Logistic回归分析方法探讨老年念珠菌血症患者预后的影响因素.结果 75例患者血培养共分离出75株念珠菌菌株,其中白色念珠菌22株(29.3%),非白色念珠菌为53株(70.7%);非白色念珠菌对氟康唑敏感率低,病死率达48.0%.多因素Logistic回归分析显示,感染性休克、合并细菌血症、血清肌酐升高及感染相关器官功能衰竭评分(SOFA评分)＞10分是死亡的独立危险因素(Ward值分别为6.34、5.15、8.04、6.82,均为P＜0.05).结论 老年院内获得性念珠菌血症患者病死率高,感染以非白色念珠菌为主,且对氟康唑耐药,应加强真菌药敏监测及危险因素监测,及时、合理使用抗真菌药物有助于改善预后.     

系统性红斑狼疮合并感染130例回顾性分析

目的 了解系统性红斑狼疮(SEE)住院患者的感染情况,探讨SLE患者感染发生的相关危险因素.方法 对2002年5月至2007年7月华山医院SLE住院患者的感染发生情况进行回顾性研究,包括感染部位及感染病原体;对病原菌的耐药情况进行分析;选择SLE患者感染的可疑危险因素,进行单因素分析和Logistic多因素分析.结果 533例SLE患者中发生感染130例,感染发生率为24.4%.1例患者因呼吸道感染死亡.SLE患者常见的感染部位依次为呼吸道(56.9%)、尿道(23.8%)及皮肤软组织(18.5%).在感染病原体构成中,细菌最常见(53.3%),以革兰阴性菌为主,其次为真菌(39.2%),两者合并感染比例高.尚有7例结核患者和10例带状疱疹患者.SLE患者感染最常见菌株为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌及白色念珠菌.细菌药敏试验结果显示耐药菌株比例较高.革兰阴性菌对头孢哌酮,舒巴坦及碳青霉烯类的敏感率较高.感染相关危险因素分析提示老年、低白蛋白血症、中度贫血及大剂量激素治疗为SLE患者感染发生的独立危险因素.结论 呼吸道及尿道为SLE患者最常见的感染部位,病原菌以革兰阴性菌多见,可选用头孢哌酮/舒巴坦或碳青霉烯类药物作为经验性抗菌治疗.     

Invasive fungal infection in systemic lupus erythematosus: an analysis of 15 cases and a literature review

OBJECTIVE: To analyse 15 cases of invasive fungal infection and mortality parameters in the largest series in the last 35 yrs of patients with systemic lupus erythematosus (SLE) at a single medical centre. METHODS: Fifteen patients with SLE and invasive fungal infections were retrospectively enrolled. Clinical and laboratory data, fungal species and infected sites, corticosteroid and immunosuppressant doses and SLE disease activity index were assessed retrospectively. Comparison and correlation analyses utilized Fisher's exact test, the chi-square test, Mann-Whitney U-test or the Wilcoxon signed-rank test where appropriate. RESULTS: In contrast to other review reports, Cryptococcus neoformans was the most commonly identified fungus in this Taiwanese series. Notably, the prevalence of autoimmune haemolytic anaemia and positive results for the anti-cardiolipin antibody in this study were significantly higher than those in SLE patients in general (P < 0.0001 and P < 0.0001, respectively). Fungal infection contributed to cause of death in 7 of 15 (46.7%) patients, of which Cryptococcus neoformans accounted for six of these infections. Low-dose prednisolone (<1 or <0.5 mg/kg/day based on arbitrary division) prior to fungal infection tended to correlate with 1 yr mortality after diagnosis of SLE (P = 0.077 or P = 0.080). However, following fungal infection, patients who died from infection itself had been prescribed with higher prednisolone dose or equivalent than surviving patients (P = 0.016). All SLE patients with fungal infections had active SLE (SLEDAI >7). CONCLUSIONS: Cryptococcus neoformans infection accounted for most fatalities in SLE patients with fungal infections in this series. Active lupus disease is probably a risk factor for fungal infection in SLE patients. Notably, low prednisolone doses prior to fungal infection or high prednisolone doses following fungal infection tended to associate with or correlated to fatality, respectively. Therefore, we suggest that different prednisolone doses prescribed at various times impact the incidence of fungal infection and its associated mortality.     

Emerging opportunistic yeast infections

A growing population of immunosuppressed patients has resulted in increasingly frequent diagnoses of invasive fungal infections, including those caused by unusual yeasts. The incidence of non-albicans species of Candida is increasing compared with that of Candida albicans, and several species, such as Candida glabrata and Candida krusei, may be resistant to azole antifungal therapy. Trichosporon species are the second most common cause of fungaemia in patients with haematological malignant disease and are characterised by resistance to amphotericin and echinocandins and poor prognosis. Rhodotorula species belong to the family Cryptococcaceae, and are a cause of catheter-related fungaemia, sepsis, and invasive disease in severely immunosuppressed patients. An increasing number of sporadic cases of invasive fungal infections by non-neoformans cryptococci have been reported in immunocompromised hosts, especially for patients with advanced HIV infection or cancer who are undergoing transplant. Other uncommon yeasts that can cause invasive disease in severely immunosuppressed patients include Geotrichum, Hansenula, Malassezia, and Saccharomyces. Host immune status is a crucial determinant of the type of invasive fungal infection a patient is at risk for. Diagnosis can be challenging and relies heavily on traditional cultures of blood and other sterile sites, although serum (1,3)-β-D-glucan testing might have an adjunctive role. Although rare yeasts are emerging as opportunistic human pathogens, diagnosis remains challenging and treatment suboptimal.     

肺部真菌感染152例病原谱再评价

目的了解肺部真菌感染的病原谱和预后。方法根据欧洲癌症研究和治疗侵袭性真菌感染协作组（EORTC）、美国变态反应和感染性疾病协会真菌病研究组（MSG）2002年制定的定义以及血液病／恶性肿瘤患者侵袭性真菌感染的诊断标准,将北京协和医院2002年1月至2006年6月诊断的152例肺部真菌感染患者按照统一的定义进行重新分组：确诊组38例,临床诊断组24例,拟诊组35例,定植组55例,重新分析病原谱。结果38例确诊肺部真菌感染的患者中,肺曲霉菌感染占首位（15／38）,其次为肺隐球菌感染（13／38）,第三为毛霉菌和其他类型丝状真菌,而真正念珠菌肺炎少见,只有2例。临床诊断组曲霉菌和曲霉菌＋念珠菌占第1位,而拟诊组以及定植组以单纯念珠菌占首位。临床诊断组病死率为58．3％,高于拟诊组（25．7％）和定植组（16．4％）。拟诊组和定植组“念珠菌肺炎”分别为28例和50例,对这78例“念珠菌肺炎”患者的预后危险因素进行分析后发现,只有急性生理和慢性病评分（APACHEⅡ）与患者的预后有关,而是否抗真菌治疗及使用何种抗真菌药物与预后无关。结论肺部真菌感染以曲霉菌占第1位,其次为隐球菌和毛霉菌,念珠菌肺炎少见。痰标本念珠菌属培养阳性作为“念珠菌肺炎”的诊断标准值得商榷。     

The fungal infections in patients hospitalized in an intensive care unit

INTRODUCTION: Over the last years, systemic fungal infections have dramatically increased in hospitalized patients. The Candida is the main pathogen caused nosocomial fungal infections. The aim of the study: The aim was to analyze frequency of occurrence of the yeast-like fungi in different biological materials isolated from the patients of an Intensive Care Unit of the University Hospital of Lodz in the period of 2000-2003. MATERIAL AND METHODS: 123 strains of fungi were analyzed with the use of API 20 C AUX test (bioMarieux). RESULTS: Among all the investigated Candida strains C. albicans accounted for 52.0%. Samples from respiratory system and urine most often contained the strains of C. albicans (56.3 and 60.5%, respectively); blood samples contained C. parapsilosis (44.8%). In patients who were untreated by bacterial antibiotics C. albicans was the most frequent species, whereas in patients who were ordered bacterial antibiotics it was C. parapsilosis that dominated. CONCLUSIONS: (1) Candida is the most frequent cause of fungal infections in patients hospitalized in an intensive care unit. (2) C. parapsilosis is the main pathogen caused bloodstream infections. This species is also more frequent in patients who were ordered antibacterial antibiotics over five days. (3). Species other than C. albicans become more and more frequent and dangerous.     

Microbiological infections in HIV positive Bahraini patients with low CD4+ T-lymphocyte count

The correlation of CD4+ T-lymphocyte count and the distribution of pathogenic or opportunistic microbial infection most commonly found in HIV positive individuals differ from one area to the other. The present study reports such findings in 67 HIV positive Bahraini patients in the period May 1997 to Nov. 1998. CD4+ T-lymphocyte count was measured using flow cytometry. Bacterial and fungal cultures were performed. Serological diagnosis was performed when indicated. Viral study was done serologically. The distribution of CD4+ T-lymphocyte count in the studied group was: 21 patients (31.3%) less than 100 cells/microl, 5 patients (7.5%) 100-200 cells/microl, 25 patients (37.3%) 201-500 cells/microl and 16 patients (23.9%) with count more than 500 cells/microl. Among patients with low CD4 count (less than 100 cells/microl) (n=21), microbial infections varied from fungal infections 66%, bacterial infections 57% and viral infections 4.8%. Bacterial infections included Salmonellosis (14.3%), Staphylococcus epidermidis (14.3%), Pseudomonas aeruginosa (9.5%), H. influenzae (9.5%), Legionellosis (4.8%) and E. coli (4.8%). Fungal infection included Candida albicans (52.4%), Pneumocystis carinii (9.5%), Cryptococcus neoformans (4.8%). Viral infection included H. simplex to (4.8%). Fungal infections were the highest common infection in thus study. The most common microbial infection was Candida albicans. P. carinii and Cryptococcus neoformans were less common than found in other studies world wide.     

血液病房2010-2012年真菌培养阳性标本145例次临床分析

目的 探讨血液病房送检真菌病原学阳性的住院患者真菌感染的发生、临床特点及转归情况。方法 回顾性分析北京协和医院2010-2012年血液病房住院患者痰、血、拭子等各个部位标本真菌培养阳性者的临床资料,分析菌种分布、感染部位、致病真菌与定植真菌的区别。结果 送检病原学的真菌检出145例次,其中酵母菌78例(53.8%),霉菌61例(42.1%)。在真菌培养阳性标本中,致病菌67例次(46.2%),其中霉菌占致病菌的85.1%;定植菌78例次(53.8%),其中酵母菌占93.6%。常见的病原检出部位依次为痰、上呼吸道、外周血,分别占77.2%、8.3%、4.1%。无菌部位阳性真菌均为致病菌,而非无菌部位中,下呼吸道致病菌检出率最高(47.3%)。在所有非无菌部位中,烟曲霉菌作为致病菌的几率要显著高于定植菌,而白色念珠菌多为定植菌(P均<0.05)。在真菌阳性的感染患者中,急性白血病占35.8%、血液肿瘤进展占32.8%。本研究中45例(67.2%)真菌感染患者经目标治疗好转,22例死亡。死亡患者中16例(72.7%)为霉菌感染。结论 我院血液科住院患者真菌检出以酵母菌和曲霉菌为主,但主要致病菌是曲霉菌,主要定植菌为酵母菌。在非无菌部位中,下呼吸道致病菌检出率最高,菌种为曲霉菌多为致病菌,而酵母菌多为定植菌。真菌感染的死亡患者以曲霉菌感染为主。     

血浆置换后肝功能衰竭患者真菌感染临床特点及其预后危险因素分析

目的 了解血浆置换(PE)后肝功能衰竭患者真菌感染的临床特征、易感因素以及影响患者预后的危险因素.方法 对PE后肝功能衰竭合并真菌感染的31例患者的临床资料及转归进行回顾性分析.应用单因素分析方法研究真菌感染的危险因素,应用多元逻辑回归探讨影响患者预后的危险因素.结果 PE患者真菌感染率为31.0%,感染部位为口腔(61.3%)、肺(32.3%)、肠道(19.4%)、泌尿系统(9.7%)、腹腔(6.5%)、血液(6.5%)和留置导管(3.2%).真菌感染种类为白念珠菌(58.1%),热带念珠菌(12.9%),末分类酵母菌(6.5%),曲霉菌(12.9%),毛霉菌(9.7%).PE后真菌感染与应用激素和抗生素、中性粒细胞降低、细菌感染、终末期肝病模型(MEI.D)积分及PE次数有关(X2值分别为5.201、7.979、14.373、6.955、12.548和9.878,P＜0.01),而与性别、年龄,低蛋白血症无关(P＞0.05).PE治疗后真菌感染组的病死率为80.6%.多因素分析显示复数菌感染、MELD积分,多部位真菌感染是影响患者预后的独立因素(P＜0.01).结论 PE治疗增加肝功能衰竭患者真菌感染概率,发生真菌感染后增加患者病死率,患者预后与复数菌感染,MELD积分和多部位真菌感染有关.     

Fungal endocarditis: analysis of 24 cases and review of the literature.

Fungal endocarditis occurs in heroin addicts, patients who have undergone cardiovascular surgery, and patients who are treated for prolonged periods with intravenous fluids and broad spectrum antibiotics. The organisms associated with endocardial infection differ in each of these groups. Candida parapsilosis is the fungal species most commonly isolated from narcotics addicts, Aspergillus species are most frequently found in patients after cardiovascular surgery, and Candida albicans occurs most frequently in patients who have received prolonged courses of intravenous fluids and antibiotics. Despite the availability of antifungal antibiotics and surgery, over 80% of patients with documented fungal endocarditis die of this infection. Thus, early diagnosis of fungal invasion and prevention of established endocardial infection are essential. Antifungal therapy and/or careful followup should be considered in patients in whom "transient fungemia" is documented by blood culture and serological and untrasonic techniques should be further evaluated as a means of early diagnosis.     

ICU侵袭性真菌感染80例回顾性分析

目的探讨ICU患者侵袭性真菌感染的临床特点,以提高临床医生对侵袭性真菌感染的认识。方法对2008年1月～2009年12月我院ICU确诊的80例侵袭性真菌感染患者的临床资料进行回顾性分析。结果80例患者均存在基础疾病及感染诱因,感染部位依次为呼吸道（39．6％）、泌尿道（22．9％）、消化道（16．7％）、腹腔（10．4％）、血液（8．3％）和颅内（2．1％）,病原菌以白色念珠菌为主（56．0％）,但非白色念珠菌有上升趋势;患者病死率高（43．8％）,病程中具有某些有意义的临床表现征象。结论ICU侵袭性真菌感染易患因素较多,发病呈上升趋势,且病死率高,充分了解其临床特点,对早期诊治有重要意义。     

Isolation of fungi in blood cultures. A review of fungal infections in the western part of Sweden 1970-1982

Relevant data were analysed from 185 patients treated for various diseases in the G?teborg area, Sweden, between 1970 and 1982 and in whom fungi were isolated in blood cultures. The increase in isolations during the first part of the study seemed to coincide with extended use of central venous catheters. However, with greater awareness of factors contributing to yeast colonization, the annual incidence fell during the latter part of the period. A disseminated fungal infection was found in 45% of cases, with a mortality of 58%. 4/42 patients with transient fungemia died; 3 from concomitant bacterial septicemia. The mortality rate was 30% in patients with antimycotic treatment because of disseminated infection. Candida albicans, followed by C. glabrata, were the most commonly isolated strains (70% and 13%, respectively). C. albicans predominated in patients with fungal endophthalmitis (100%) and in neonatal infections (95%).