Epidemiology of candidemia in oncology patients: a 6-year survey in a Portuguese central hospital

Sabino, Raquel; Veríssimo, Cristina; Brandão, João; Alves, Cı́ntia; Parada, Helena; Rosado, Laura; Paixão, Eleonora; Videira, Z.; Tendeiro, T.; Sampaio, Paula; Pais, Célia

doi:10.3109/13693780903161216

Cited by 28 publications

(22 citation statements)

References 40 publications

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“…In our study the 30‐day mortality in the ST population was higher than in patients with HM (65% vs. 46%, P < 0.001), probably because they were older and more critically ill, as evidenced by their higher APACHE II score and higher rates of ICU admission at the time of candidemia. These data concur with a single centre study from Portugal, 31 but contrast with other studies that reported similar 30‐day mortality rates among HM and ST 8,10 …”

Section: Discussionsupporting

confidence: 90%

Epidemiology of candidemia in patients with hematologic malignancies and solid tumours in Brazil

Bergamasco

Garnica

Colombo

et al. 2012

Mycoses

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Candidemia in cancer patients may differ according to the type of cancer. To characterise the epidemiology and outcome of candidemia in cancer patients from Brazilian hospitals, we compared the characteristics of patients with hematologic malignancies (HM) and solid tumours (ST). A retrospective study was performed, based on data collected from laboratory-based surveillance studies in 18 tertiary care hospitals between March/2003 and December/2007. The characteristics of patients with HM (n = 117) were compared with patients with ST (n = 248). Predictors of 30-day mortality were identified by uni- and multivariate analyses. Candidemia in HM was more likely to occur in the setting of chemotherapy, corticosteroids, neutropenia, mucositis and tunnelled central venous catheter (CVC), whereas surgery, intensive care unit admission and invasive procedures (mechanical ventilation, parenteral nutrition and CVC) were more frequent in ST. The 30-day mortality rate was higher in the ST group (65% vs. 46%, P = 0.001). Factors significantly associated with 30-day mortality were older age and intensive care unit admission. Important differences in the epidemiology and outcome of candidemia in HM and ST were observed. The characterisation of the epidemiology is important to drive preventive measures and to select appropriate therapies.

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Section: Discussionsupporting

confidence: 90%

Epidemiology of candidemia in patients with hematologic malignancies and solid tumours in Brazil

Bergamasco

Garnica

Colombo

et al. 2012

Mycoses

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“…C. parapsilosis is associated with catheter-related fungemia (32,40) and is known to colonize skin; evaluation of CVC care and infection control practices may be helpful in identifying risk factors for C. parapsilosis candidemia. C. glabrata candidemia (15.8% of the cases) was less prevalent than that reported in the United States (24 to 25%) (15,17) but more so than in certain areas of Latin America and Europe (3 to 8% of the cases) (9,37). Few large surveys have described patterns of causative Candida species in nonbloodstream infections.…”

Section: Discussionmentioning

confidence: 85%

In VitroSusceptibilities of Yeast Species to Fluconazole and Voriconazole as Determined by the 2010 National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study

et al. 2012

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We conducted active, laboratory-based surveillance for isolates from patients with invasive infections across China from August 2009 to July 2010. DNA sequencing methods were used to define species, and susceptibility to fluconazole and voriconazole was determined by the Clinical and Laboratory Standards Institute M44-A2 disk diffusion method but using up-to-date clinical breakpoints or epidemiological cutoff values. Candida spp. made up 90.5% of the 814 yeast strains isolated, followed by Cryptococcus neoformans (7.7%) and other non-Candida yeast strains (1.7%). Bloodstream isolates made up 42.9% of the strains, isolates from ascitic fluid made up 22.1%, but pus/tissue specimens yielded yeast strains in <5% of the cases. Among the Candida isolates, Candida albicans was the most common species from specimens other than blood (50.1%) but made up only 23% of the bloodstream isolates (P < 0.001). C. parapsilosis complex species were the most common Candida isolates from blood (33.2%). Uncommon bloodstream yeast strains included Trichosporon spp., C. pelliculosa, and the novel species C. quercitrusa, reported for the first time as a cause of candidemia. Most (>94%) of the isolates of C. albicans, C. tropicalis, and the C. parapsilosis complex were susceptible to fluconazole and voriconazole, as were all of the Trichosporon strains; however, 12.2% of the C. glabrata sensu stricto isolates were fluconazole resistant and 17.8% had non-wild-type susceptibility to voriconazole. Seven C. tropicalis strains were cross-resistant to fluconazole and voriconazole; six were from patients in the same institution. Resistance to fluconazole and voriconazole was seen in 31.9% and 13.3% of the uncommon Candida and non-Candida yeast strains, respectively. Causative species and azole susceptibility varied with the geographic region. This study provided clinically useful data on yeast strains and their antifungal susceptibilities in China.

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“…Whether or not all these changes impact the characteristics and outcome of candidemia among adults with malignancy needs to be further investigated. Several retrospective monocentric studies described the local epidemiology of candidemia among patients with malignancy [15–17] and only two recent prospective studies concerned cancer patients [18, 19]. No study has ever analyzed the characteristics and outcome of infection in patients with solid tumor or hematological malignancy developing candidemia and the impact of their hospitalization in intensive care unit (ICU) [20].…”

Section: Introductionmentioning

confidence: 99%

The risk and clinical outcome of candidemia depending on underlying malignancy

et al. 2017

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PurposeTo assess the risk factors and outcomes associated with fungemia caused by the six most commonly occurring Candida species in patients with and without malignancies.MethodsAnalysis 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).ResultsOf 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 catheter, 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.ConclusionThe clinical context of underlying malignancy and hospitalization in ICU may be relevant to the initial management of candidemia.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-017-4743-y) contains supplementary material, which is available to authorized users.

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Epidemiology of candidemia in oncology patients: a 6-year survey in a Portuguese central hospital

Cited by 28 publications

References 40 publications

Epidemiology of candidemia in patients with hematologic malignancies and solid tumours in Brazil

Epidemiology of candidemia in patients with hematologic malignancies and solid tumours in Brazil

In VitroSusceptibilities of Yeast Species to Fluconazole and Voriconazole as Determined by the 2010 National China Hospital Invasive Fungal Surveillance Net (CHIF-NET) Study

The risk and clinical outcome of candidemia depending on underlying malignancy

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