Risk Factors and Outcome for Breakthrough Candidemia in Patients with Cancer

JIN-WON CHUNG, MD, YEE KYUNG KWAK, MD, YANG SOO KIM, MD and NAM JOONG KIM, MD,

Author address: 

Div. of Infectious diseases, Asan. Medical Ctr., Univ. of Ulsan Coll. of Med, Seoul, Republic of Korea

Abstract: 

Background: Hematogenous candidiasis is a common cause of nosocomial bloodstream infection. This infection adds to the morbidity and mortality rates in cancer patients. While candidemia that develops during systemic antifungal prophylaxis or therapy (breakthrough candidemia, BT candidemia) has been reported increasingly, there was no report in Asia. We evaluated a consecutive series of cancer patients with candidemia in order to identify the risk factors and outcomes in BT and non-BT candidemia. Methods: This study was done by reviewing the medical records of all adult patients who had candidemia from 1997 to 2002 at AMC. BT candidemia was defined as the occurrence of candidemia in a patient receiving at least 5 days of systemic fluconazole or amphotericin B. Results: During this period, 273 episodes of candidemia occurred. Fifty-four episodes of candidemia were diagnosed in 46 patients with cancer. A total of 10 episodes (18.5%) had BT candidemia and 6 patients had 2 separate episodes of candidemia. The species distribution and frequency of catheter-related infection among cases of BT and non-BT candidemia were similar. BT candidemia had a tendency to occur more frequently in the hematologic unit than the non-hematologic unit (P0.08). Although profound neutropenia and disseminated candidiasis were common in BT group, there was no significant difference (P0.17, P0.07, respectively). Heavy antibiotics exposure (3) was not associated with BT candidemia (P0.17), whereas the duration of prior antibiotic therapy and duration of profound neutropenia were identified as risk factors for BT candidemia (P0.01, P0.02, respectively). The mortality rate at 30 days after the first positive blood culture was 70% (7/10) in the BT group compared with 47.7% (21/44) in the non-BT group. However, death due to candidemia was not significantly different in the 2 groups (85.7% vs 70%, P0.08). Conclusions: In our study, the duration of prior antibiotic therapy and profound neutropenia were associated with an increased risk for BT candidemia.
2003

abstract No: 

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Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st