Increase of Candidemia due to non-albicans Candida Species in Oncohematological (OH) Patients in Spain

Ref ID: 18794

Author:

I. Ruiz-Camps, MD, PhD – Senior Consultant, Mireia Puig, Patricia Muñoz, Mario Fernández-Ruiz, Alberto Delgado-Iribarren, Maricela Valerio, José M Aguado;

Author address:

on behalf of CANDIPOP Project, GEIH-GEMICOMED (SEIMC) and REIPI., Barcelona, Spain.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: We aimed to describe the distribution of Candida species, antifungal susceptibility and outcome in patients with hematological (HM) and oncological (O) malignancies in Spain looking for differences between these two groups Methods: A prospective multicenter population-based surveillance program on Candida BSI was implemented in 29 hospitals from 5 areas in Spain (population 7,237,228) from May 2010 to April 2011. Case was defined as the first positive blood culture of Candida in a surveillance area resident. We analysed crude mortality rate (within 30 days) and early mortality (3-7 days).
Results: Among 752 candidemia episodes, 283 (39%) were detected in OH (225 and 58 respectively); 45 (15.9%) episodes were breakthrough candidemias. Risk factors were: 35% previous immunosuppressive therapy (25.1% chemotherapy), 11.3% neutropenia and 9.5% mucositis. 79.9% cases had central venous catheter (32.3% long-term) and 69 (24.4%) patients had received a prior azole therapy. Candidemia was catheter-related in 37% in both HM and O patients. C.albicans was the most common isolate (42%), followed by C.parapsilosis (21.5%), C.glabrata (16%), C.tropicalis (9.7%), C.guilliermondii (3.1%), C.krusei (3%) and others (4.9%). In HM patients non-C.albicans species were more frequent (77.6% vs 52%, p< 0.000) and, particularly, C.tropicalis and C,guilliermondii were more likely to occur (20% vs 7 %, and 8.8% vs 1.8%, respectively). Azole prophylaxis was a risk factor for C.krusei candidemia. Overall rate of decreased susceptibility to fluconazole (MIC>4) was higher in OH patients (17% vs 13.5%, p=0.16). The mortality rate was 29.7 % within 30 days (13.4% within 7 days) without any differences between HM and O patients. Multivariate analysis showed that early catheter removal was a protective factor for early mortality in those patients whose source of infection was either primary or catheter-related (OR, 0.024; 95% CI, 0.06 to 0.82). Conclusions: Non-albicans Candida species are emerging as the predominant isolates especially in hematological patients. Early catheter removal is recommended for preventing early mortality.

Abstract Number: M-312

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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