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The risk and clinical outcome of candidemia depending on underlying malignancy

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Abstract Purpose: To assess the risk factors and outcomes associated with fungemia caused by the six most commonly occur‑ ring Candida species in patients with and without malignancies. Methods: Analysis of the episodes of fungemia due to common Candida species in adults, based on an active hospital‑based surveillance program (Paris area, France, 2002 to 2014). Results: Of the 3417 patients (3666 isolates), 1164 (34.1%) had a solid tumor (45.7% digestive tract) and 586 (17.1%) a hematological malignancy (41.8% lymphoma, 33.5% acute leukemia). The hematology patients were significantly younger, more often pre‑exposed to antifungals, more often infected by C. tropicalis, C. krusei, or C. kefyr, and more often treated in the first instance with an echinocandin. Compared with inpatients who were not in ICU at the time of fungemia, those in ICU were less frequently infected by C. parapsilosis (p < 0.02), had more recent surgery (p < 0.03), and died more frequently before day 8 and day 30 (p < 0.0001). An increase in crude mortality over time in ICU was observed only in oncology patients (p < 0.04). For all patients, lack of prescription of antifungals despite knowledge of positive blood culture increased the risk of death. The odds of being infected by a given Candida species compared with C. albicans were uneven regarding age, gender, type of malignancy, hospitalization in ICU, central venous cath‑ eter, HIV status, intravenous drug addiction, and previous exposure to antifungal drugs. Compared with C. albicans, C. glabrata (OR = 0.69 [0.54–0.89]) and C. parapsilosis (OR = 0.49 [0.35–0.67]) were associated with a decreased risk of death by day 8 and day 30. Conclusion: The clinical context of underlying malignancy and hospitalization in ICU may be relevant to the initial management of candidemia. Keywords: Candida, Echinocandins, Fluconazole, Hematological malignancy, Cancer, ICU, Non‑albicans species

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Judul Seri

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No. Panggil

Artikel

Penerbit

USA : Springer., 2016

Deskripsi Fisik

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Bahasa

English

ISBN/ISSN

DOI 10.1007/s00134-0

Klasifikasi

NONE

Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

Intensive Care Med (2017) 43:652–662

Subjek

Medicine
candidemia depending

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