Yeast fungaemia among injection drug users in France (2012-2022): a cross-sectional observational study.

Abstract

Intravenous injection drug use (IVDU) is an established but infrequent risk factor for yeast fungaemia. We aimed to identify features and outcomes of yeast fungaemia associated with IVDU in a nationwide surveillance network in France. We prospectively included episodes of yeast fungaemia in adults between 2012 and 2022. Episodes with any history of IVDU were considered IVDU-associated. We compared clinical characteristics, infecting species, antifungal treatments, and 90-day mortality between groups. We used Fisher's exact test for categorical variables and the Kruskal-Wallis test for continuous variables. We recorded 9549 episodes of yeast fungaemia among 9132 adults. Among these, 183 (1·9%) were IVDU-associated. Compared with non-IVDU, individuals with IVDU-associated fungaemia were younger and less likely to have a history of malignancy (13·8%, 20/145 <i>vs.</i> 49·5%, 4447/8987, p < 0·0001) or recent surgery (24·3%, 34/140 <i>vs.</i> 37·3%, 3261/8,733, p = 0·0014), and more likely to have deep-seated infections (14·5%, 21/145 <i>vs.</i> 3·4%, 307/8987, p < 0·0001). IVDU cases less often involved <i>Candida albicans</i> (30·1%, 55/183 <i>vs.</i> 47·6%, 4458/9366, p < 0·0001) and more often involved mixed-species infections (13·1%, 24/183 <i>vs.</i> 4·3%, 402/9366), p < 0·0001. <i>Meyerozyma guilliermondii</i> and <i>Wickerhamomyces anomalus</i> were overrepresented among IVDU cases (6·0%, 11/183 <i>vs.</i> 0·5%, 48/9366, p < 0·0001 and 5·5%, 10/183 <i>vs.</i> 0·05%, 5/9366, p < 0·0001, respectively). The crude 90-day case-fatality ratio was 20·7% (95% CI: 13·7%-29·2%) in the IVDU group versus 48·4% (95% CI: 47·3-49·5%) for non-IVDU. IVDU-associated yeast fungaemia presents distinct clinical and microbiological characteristics, highlighting the need for tailored diagnosis and management. Financial support from Santé Publique France and Institut Pasteur, Paris.