The Epidemiology and Outcomes of Candidemia in Hematopoietic Cell Transplantation

Ref ID: 18757

Author:

L. Gold, Pharm D – Pharmacy Resident, J. Kriengkauykiat, PharmD – ID Pharmacist, B. Tegtmeier, PhD – Sr Analytics Specialist, S. Dadwal, MD – ID Physician, J. Ito, MD – Chief ID Physician;

Author address:

City of Hope, Duarte, CA.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: Candidemia has a reported incidence of 1-3% and onset post HCT of 61 days. Historically, prior to prophylaxis, the incidence was 11% and onset of 14 days post HCT. This study evaluated treatment and outcomes of candidemia. Methods: A retrospective chart review was performed on patients with candidemia between 2006 and 2010 (n= 50) in HCT. Patient characteristics, treatment, and outcomes data were collected. 90-day response to therapy and mortality were evaluated. Responders(complete/partial) were also compared to nonresponders (stable, progressive disease, death). Results: 2% (50/2618) of HCT developed candidemia. 34 (68%) patients had acute leukemia, 41 (82%) allogeneic HCT, and 40 (80%) had coinfection with other pathogens. 80% were non-Candida albicans species with the three most predominant species including C. parapsilosis (34%), C. krusei (18%), and C. glabrata (14%). Comparing responders (22%, 11/50) to nonresponders (78%, 39/50): candidemia onset from HCT was a median of 43 vs 145 days (p = 0.02), steroid use at onset was 36.4% vs 79.5% (p < 0.001), presence of GVHD was 27% vs. 48.7% (p=0.31), and duration of TPN prior to onset was 9 vs 21 days (p=0.07). Candida dissemination (in addition to candidemia) was seen in 1 (9%) responders and 10 (26%) nonresponders, p=0.42. No differences seen in pressor/inotrope use or ICU stay. A higher proportion of nonresponders (49%) had breakthrough isolates resistant to antifungal prophylaxis than responders (18%), p = 0.09; all cases of C. parapsilosis broke through on single agent echinocandin. For antifungal treatment, 8 (73%) responders were on combination therapy vs 18 (46%) nonresponders, p=0.17. A higher response rate (50%, 5/10) was seen if the Hickman or PICC catheter was removed within 24 hours vs later (13%, 3/23), p=0.04. At 90 days, mortality was 74% (37/50), 4% (2/50) had persistent Candida infection, and 22% (11/50) were Candida free. Conclusions: Candidemia breakthrough occurred while on antifungal agent not active against the isolate, which was also associated with lower response. Removing the central line within 24 hours was a significant factor in improving outcomes.

Abstract Number: T-349

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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