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Candida lusitaniae fungaemia in cancer patients: risk factors, amphotericin B-mutational frequency and killing and outcome

Abstract number: 1733_760

Atkinson B., Lewis R., Kontoyiannis D.

Introduction:Candida lusitaniae, a Candida species frequently resistant to amphotericin-B (AMB), is a rare cause of candidaemia, seen typically in immunocompromised patients (pts). The clinical significance of this in vitro resistance phenotype as well as the risk factors for and clinical presentation of C. lusitaniae fungaemia in comparison with those of C. albicans have not been completely characterised.

Methods: We reviewed 13 consecutive cases of C. lusitaniae fungaemia and compared them with 41 consecutive cases of C. albicans fungaemia (1990–2004). We also determined mutational frequency of an AMB-susceptible C. lusitaniae isolate as well as time-kill rates to AMB (1 mg/mL, 2 mg/mL) in comparison to C. albicans and C. glabrata reference strains (controls).

Results: In univariate analysis, pts having C. lusitaniae fungaemia were more likely to have leukaemia as an underlying disease (54% vs 15%, P = 0.007), higher APACHE II score (median 15.5vs 12, 95% CI; 0.68–8.05), profound neutropenia (38% vs 15%, P = 0.007), sustained neutropenia (38%vs 7%, P = 0.001), concurrent infections (85%vs 54%, P = 0.05), received growth factors (70% vs 22%, P = 0.005) and systemic high dose steroids (38% vs 5%, P = 0.006). These pts had more frequent exposure to antifungal prophylaxis (38%vs 11%, P = 0.048), higher treatment failure (38% vs 19%, P = 0.028) and need for ICU transfer (54%vs 22%, P = 0.04). The two groups did not differ in frequency of catheter-associated fungaemia. In multivariate analysis, pts having C. lusitaniae fungaemia were more likely to have underlying neutropenia (P = 0.001), stem cell transplantation (P = 0.014) and to have received prior antifungals (P = 0.04). Mutational frequency to AMB for the C. lusitaniae isolate was 8×10-5 and <1×10-9 for both C. albicans and C. glabrata isolates. In addition, kill rates of AMB were low for C. lusitaniae compared to the other isolates.

Conclusion: (1) Host determinants associated with greater susceptibility to C. lusitaniae are underlying haematologic malignancy and prolonged neutropenia, (2) pts having C. lusitaniae fungaemia appeared to be more ill than those having C. albicans fungaemia, (3) C. lusitaniae isolates, even originally susceptible to AMB, might be less amenable to AMB therapy.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Subject:
Location: ICC, Munich, Germany
Presentation type:
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