INTRAVENOUS drug use (IVDU) is a rare but clinically distinct risk factor for yeast fungaemia, according to a large, decade-long study from France’s national surveillance network.
Researchers analysed data from 9,549 episodes of yeast fungaemia in 9,132 adults collected prospectively between 2012–2022, identifying 183 cases (1.9%) linked to a history of IVDU. All IVDU-associated cases were compared to non-IVDU cases across several dimensions, including demographics, underlying conditions, fungal species, treatment, and 90-day mortality. Standard statistical tests were applied to assess group differences. The goal was to better understand how IVDU influences the clinical presentation and outcomes of yeast bloodstream infections.
Patients with IVDU-associated fungaemia patients were significantly younger and had fewer traditional risk factors such as malignancy (13.8% vs. 49.5%, p<0.0001) and recent surgery (24.3% vs. 37.3%, p=0.0014). However, deep-seated infections were markedly more common in this group (14.5% vs. 3.4%, p<0.0001). The microbiological profile also differed: Candida albicans was less frequently isolated in IVDU cases (30.1% vs. 47.6%, p<0.0001), whereas mixed-species infections were substantially more common (13.1% vs. 4.3%, p<0.0001). Notably, rare species such as Meyerozyma guilliermondii (6.0% vs. 0.5%, p<0.0001) and Wickerhamomyces anomalus (5.5% vs. 0.05%, p<0.0001) were significantly overrepresented among IVDU cases. Despite their higher rates of deep-seated infection, individuals with IVDU-associated fungaemia had a considerably lower crude 90-day case-fatality rate (20.7%, 95% CI:13.7–29.2%) compared to non-IVDU patients (48.4%, 95% CI: 47.3–49.5%).
These findings highlight a distinct clinical entity of yeast fungaemia among people who inject drugs, warranting tailored diagnostic and management strategies. Recognising these unique patterns may help optimise antifungal therapy and improve outcomes in this population.
Reference
Paccoud O et al. Yeast fungaemia among injection drug users in France (2012–2022): a cross-sectional observational study. Lancet Reg Health Eur. 2025; DOI: 10.1016/j.lanepe.2025.101365.
