Candidiasis in patients with haematological malignancies, in a tertiary care cancer centre (20012007): stable incidence but changing epidemiology of a still frequently lethal infection
Abstract number: O454
Sipsas N.V., Lewis R.E., Kontoyiannis D.P.
Objective: In the era of ever expanding anti-Candida armamentarium, there has not been recent large series on the incidence, microbiology, resistance patterns of candidiasis in high risk patients with hematologic malignancy and or stem cell transplantation.
Methods: We retrospectively reviewed the records of adult patients with candidaemia and or candidiasis (EORTC criteria), treated for hematological malignancies (March 2001-February 2007). Demographic characteristics, clinical and microbiological data, outcomes, as well as MIC of antifungal agents (CLSI method), were recorded.
Results: A total of 173 episodes of candidaemia (170 patients) were analysed. C. albicans and C. parapsilosis were isolated most commonly (25% and 24% respectively). However, frequently azole-resistant Candida species such as C. glabrata or C. krusei accounted for only 22% of all episodes (5% and 17% respectively). The incidence of candidaemia (per 100.000 inpatient days) remained relatively stable from 13.9 in 2001 to 19.2 in 2006 (p=NS). 72% of episodes were breakthrough candidiasis to prior antifungal prophylaxis. Twenty five percent of the 173 isolates were resistant to fluconazole (67% of C. glabrata, or 6 out of 9 isolates), and 7% resistant to voriconazole. Of the 59 Candida isolates with caspofungin MICs, 4 (7%) had an MIC > 2. In contrast, resistance to amphotericin B (MIC > 2) was uncommon (1%). There was no trend in prevalent Candida species or patterns of resistance over the study period. Overall 30 day mortality was 38% and the 30 day attributable mortality was 17%. Factors associated significantly 30-day overall mortality (multivariate analysis) were age >50 years, intercurrent infection and neutrophil count <100/ml at diagnosis of candidiasis; for 30-day attributable mortality age >50 years and sustained candidaemia. The Candida species associated with the highest mortality (44%) was C. glabrata.
Conclusion: Despite widespread use of antifungal prophylaxis in high risk hematology patients, the incidence of candidiasis remained stable. More over, breakthrough infections, frequent in vitro resistance (especially to fluconazole), the predominance of non-albicans Candida species and high crude mortality continue to pose significant challenges.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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