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Abstract：
BACKGROUND: While fungaemia caused by two or more different species of yeasts (mixed fungaemia, MF) is infrequent, it might be underestimated.
OBJECTIVE: 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.
METHODS: Data sources were PubMed and Scopus.
METHODS: Studies reporting ten or more mixed fungaemia episodes.
BACKGROUND: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
METHODS: Data sources were PubMed and Scopus.
METHODS: Studies reporting ten or more mixed fungaemia episodes.
BACKGROUND: 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.
CONCLUSIONS: 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.
摘要：
背景：虽然由两种或两种以上不同种类的酵母引起的真菌血症（混合真菌血症，MF)不常见，这可能被低估了。
目的：本研究旨在确定MF的发病率，患者的临床特征，和抗真菌药敏谱的分离与文献的系统回顾。
方法：数据来源为PubMed和Scopus。
方法：研究报告了10次或更多次混合真菌血症发作。
背景：研究包括2000年1月至2018年8月在Hacettepe大学医院的成人MF发作，土耳其。隔离,分离株的鉴定和抗真菌药敏试验(AST)采用标准真菌学方法.回顾性获得患者数据。根据PRISMA系统评价指南使用相关关键词进行文献检索。确定了总共32例患者的33例MF发作。在所有的真菌血症发作中,MF发生率为3.7%(33/883)。所有患者都有一种或多种基础疾病，其中实体器官癌（50.0％，16/32）是最常见的。总死亡率为51.5%（17/33）。初始治疗最优选的抗真菌药物是氟康唑（48.5%，16/33）和棘白菌素（39.4%，13/33).在15次发作中检测到氟康唑敏感剂量依赖性（S-DD）或耐药的念珠菌。一种近平滑梭菌的分离株被AFST分类为S-DD。所有念珠菌分离物均对棘白菌素类敏感。在两次发作中检测到具有固有抗性/对棘白菌素和氟康唑敏感性降低的非念珠菌酵母。对文献的系统回顾显示，有24项研究报告了十多次MF发作。方法是可变的。据报道，当使用显色琼脂时，检出率有所提高。大多数研究强调检测具有降低的敏感性的分离株。
结论：虽然罕见，MF率受到检测方法的影响，近年来有所改善。氟康唑和棘白菌素根据目前的指南建议用于初始治疗；然而，检测到对两者都不敏感的分离株。混合感染的检测提供了最佳治疗的机会。
目的：本研究旨在确定MF的发病率，患者的临床特征，和抗真菌药敏谱的分离与文献的系统回顾。
方法：数据来源为PubMed和Scopus。
方法：研究报告了10次或更多次混合真菌血症发作。
背景：研究包括2000年1月至2018年8月在Hacettepe大学医院的成人MF发作，土耳其。隔离,分离株的鉴定和抗真菌药敏试验(AST)采用标准真菌学方法.回顾性获得患者数据。根据PRISMA系统评价指南使用相关关键词进行文献检索。确定了总共32例患者的33例MF发作。在所有的真菌血症发作中,MF发生率为3.7%(33/883)。所有患者都有一种或多种基础疾病，其中实体器官癌（50.0％，16/32）是最常见的。总死亡率为51.5%（17/33）。初始治疗最优选的抗真菌药物是氟康唑（48.5%，16/33）和棘白菌素（39.4%，13/33).在15次发作中检测到氟康唑敏感剂量依赖性（S-DD）或耐药的念珠菌。一种近平滑梭菌的分离株被AFST分类为S-DD。所有念珠菌分离物均对棘白菌素类敏感。在两次发作中检测到具有固有抗性/对棘白菌素和氟康唑敏感性降低的非念珠菌酵母。对文献的系统回顾显示，有24项研究报告了十多次MF发作。方法是可变的。据报道，当使用显色琼脂时，检出率有所提高。大多数研究强调检测具有降低的敏感性的分离株。
结论：虽然罕见，MF率受到检测方法的影响，近年来有所改善。氟康唑和棘白菌素根据目前的指南建议用于初始治疗；然而，检测到对两者都不敏感的分离株。混合感染的检测提供了最佳治疗的机会。
