Epidemiology and Prognostic Factors of Candidemia in Cancer Patients

Abstract

AimThe study of candidemia in cancer patients has been limited. This retrospective study aims to investigate the epidemiologic characteristics and prognostic factors of candidemia among cancer patients.Materials and MethodsFrom 2009 to 2012, cancer patients with candidemia were identified at a hospital in Taiwan. The medical records of all patients with bloodstream infections due to Candida species were retrospectively reviewed.ResultsDuring the four-year period, a total of 242 episodes of candidemia were identified among cancer patients. Half of these patients were classified as elderly (≥65 years old), and more than 95% of the candidemia episodes were classified as healthcare-associated infections. Among the 242 cancer patients with candidemia, head and neck cancer was the most common, followed by gastrointestinal tract and lung cancer. Additionally, most of the patients had variable underlying conditions, such as the presence of CVC (99%) or prior exposure to broad-spectrum antibiotics (93%) and were receiving an immunosuppressant (86%). Overall, C. albicans (n = 132, 54.5%) was the most common pathogen, followed by C. tropicalis (n = 52, 21.5%), C. parapsilosis (n = 38, 15.7%), and C. glabrata (n = 29, 12.0%). Seventeen patients had polycandidal candidemia, and 77 patients had concomitant bacteremia. Approximately one-third of the patients required admission to the intensive care unit (ICU) or mechanical ventilation, and the overall in-hospital mortality was 50.8%. Multivariable analysis showed that the in-hospital mortality was significantly associated with only the non-use of antifungal agents and acute respiratory failure (P<.001).ConclusionsCandidemia can develop in patients with both solid cancer and hematological malignancy, especially for patients with underlying conditions. Overall, the associated morbidity and mortality due to Candidemia remain high. It was also determined that the non-use of antifungal agents and acute respiratory failure conditions were associated with in-hospital mortality.

The risk and clinical outcome of candidemia depending on underlying malignancy

“…As already reported [44] and shown here, a major observation is that a constant risk factor for death was the lack of antifungal prescription despite knowledge of the blood culture positivity, with no influence of the initial antifungal choice. In contrast to what is observed in the USA [7, 45], resistance to antifungals is not yet of concern in our area, with overall less than 1% resistance to caspofungin in isolates not identified as C. parapsilosis , less than 2.3% resistance to fluconazole in isolates not identified as C. krusei or C. glabrata , and no increase in these figures over time.…”

Azole Antifungal Resistance in Candida albicans and Emerging Non-albicans Candida Species

“…In the Asia-Pacific region, C. tropicalis has been reported to constitute 20–45% of Candida isolates (Kothari and Sagar, 2009; Pfaller et al, 2010). C. tropicalis infections are commonly associated with malignancy, with some studies reporting higher prevalence among patients with hematologic diseases such as acute myeloid leukemia (Weinberger et al, 2005; Nucci and Colombo, 2007; Tang et al, 2014, 2015; Cornely et al, 2015). Mortality associated with C. tropicalis candidemia in these populations unfortunately remains high, ranging from 30 to 70%, with the highest rates most commonly observed among the elderly (Weinberger et al, 2005; Nucci and Colombo, 2007; Morii et al, 2014; Cornely et al, 2015; Wang et al, 2015).…”

Components of the Calcium-Calcineurin Signaling Pathway in Fungal Cells and Their Potential as Antifungal Targets

“…nvasive fungal infections have become frequent in severely immunocompromised individuals, such as transplant, cancer chemotherapy, and HIV-infected patients (1,2). Candida spp., Aspergillus spp., and Cryptococcus spp.…”