In Vitro Susceptibility of Bloodstream Candidiasis(BC) in Cancer Patients: Correlation with Outcome of Antifungal Therapy.

A. ANTONIADOU, H.A. TORRES, R.E. LEWIS, I.I. RAAD, J. THORNBY, J.J. TARRAND, K.V.I. ROLSTON, X.Y. HAN, G.P. BODEY, D.P. KONTOYIANNIS

Abstract: 

Background: Since the 1990s changing trends in species distribution and susceptibility of BC in cancer patients (Pts) was documented; few data are available regarding the correlation between in vitro antifungal susceptibility and outcome in BC. Methods: We evaluated the influence of in vitro antifungal susceptibility and other risk factors for antifungal therapy failure in BC. Episodes (n=140) of BC in cancer Pts (1998-2001) were retrospectively analyzed along with in vitro susceptibility to amphotericin B (AMB), fluconazole (FLU), and itraconazole (ITR) (NCCLS M27-A). Pts were evaluable for response if they received > 5d of therapy. We excluded mixed and CVC-related BC. Appropriate therapy was defined as therapy of > 5d with an antifungal(s) that was active in vitro. For FLU susceptible dose dependent (S-DD) Candida isolates, we defined appropriate therapy a dose of FLU 600mg/d. Results: The Candida species distribution was 31% albicans, 23% parapsilosis, 23% glabrata, 11% krusei, and 9% tropicalis, and other species 3%. Overall, AMB was the most active agent in vitro with only 2% of isolates exhibiting resistance (>1 mg/l). S-DD was seen with 12 and 20% of FLU and ITRA isolates. Resistance to FLU and ITRA were seen in 12% and 26% of isolates, respectively. Eighty Pts were evaluable for outcome analysis. In multivariate analysis, the following factors emerged as independent predictors of failure of the initial antifungal therapy: leukemia (p=0.01), BMT (p=0.006), ICU at onset of infection (p=0.02) and inappropriate antifungal therapy (p=0.04). Conclusion: Host-derived factors and appropriate antifungal therapy both influence outcome of BC in cancer patients.
2002

abstract No: 

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Full conference title: 

42nd Interscience Conference on Antimicrobial Agents and Chemotherapy
    • ICAAC 42nd