Invasive Candidiasis in the Neutropenic Cancer Patient

Gamaletsou, Maria N.; Sipsas, Nikolaos V.; Kontoyiannis, Dimitrios P.

doi:10.1007/s12281-010-0044-4

Cited by 4 publications

(2 citation statements)

References 53 publications

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“…Among neutropenic patients with hematological malignancies, recent studies indicate that removal of central vascular catheters does not improve outcome. 5,6 This finding is consistent with the most likely portal of entry being the alimentary tract. If a multilumen catheter is not immediately removed, antifungal therapy should be administered parenterally through all lumens.…”

Section: Specific Ifis Associated With Neutropenia Candidiasissupporting

confidence: 84%

Treatment of fungal disease in the setting of neutropenia

Walsh

Gamaletsou

2013

Hematology

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Invasive fungal infections are important causes of morbidity and attributable mortality in neutropenic patients with hematological malignancies, myelodysplasia, and aplastic anemia. Successful risk-based strategies can be implemented for prophylaxis, empirical therapy, and preemptive therapy for the prevention and early treatment of invasive fungal infections in neutropenic hosts. The use of echinocandins for invasive candidiasis and voriconazole for invasive aspergillosis has significantly improved outcome. Recent studies demonstrate, however, that resistant fungal pathogens may emerge during the course of these antifungal interventions. Although triazole-resistant Candida spp. have been well described as causes of breakthrough candidemia, other organisms now pose a similar threat. Such organisms include echinocandin-resistant Candida glabrata and Candida parapsilosis species complex. The Mucorales, Fusarium spp., and Scedosporium spp. may emerge in the setting of voriconazole prophylaxis. The challenges of these emerging pathogens underscore the need for the development of new antifungal agents and strategies.

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Section: Specific Ifis Associated With Neutropenia Candidiasissupporting

confidence: 84%

Treatment of fungal disease in the setting of neutropenia

Walsh

Gamaletsou

2013

Hematology

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“…However, in contrast to the ICU setting, no trial has prospectively assessed the role of Candida spp. colonization or 1,3‐ ß ‐ d ‐glucan in these patients [64]. 1,3‐ ß ‐ d ‐glucan was assessed previously in a meta‐analysis by Lamoth et al.…”

Section: Empiric or Pre‐emptive (Diagnostic Driven) Antifungal Therapymentioning

confidence: 99%

ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT)

Ullmann

Akova

Herbrecht

et al. 2012

Clinical Microbiology and Infection

295

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Fungal diseases still play a major role in morbidity and mortality in patients with haematological malignancies, including those undergoing haematopoietic stem cell transplantation. Although Aspergillus and other filamentous fungal diseases remain a major concern, Candida infections are still a major cause of mortality. This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases. Anti-Candida prophylaxis is only recommended for patients receiving allogeneic stem cell transplantation. The authors recognize that the recommendations would have most likely been different if the purpose would have been prevention of all fungal infections (e.g. aspergillosis). In targeted treatment of candidaemia, recommendations for treatment are available for all echinocandins, that is anidulafungin (AI), caspofungin (AI) and micafungin (AI), although a warning for resistance is expressed. Liposomal amphotericin B received a BI recommendation due to higher number of reported adverse events in the trials. Amphotericin B deoxycholate should not be used (DII); and fluconazole was rated CI because of a change in epidemiology in some areas in Europe. Removal of central venous catheters is recommended during candidaemia but if catheter retention is a clinical necessity, treatment with an echinocandin is an option (CII(t) ). In chronic disseminated candidiasis therapy, recommendations are liposomal amphotericin B for 8 weeks (AIII), fluconazole for >3 months or other azoles (BIII). Granulocyte transfusions are only an option in desperate cases of patients with Candida disease and neutropenia (CIII).

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