Prospective evaluation of Candida species colonization in hospitalized cancer patients: impact on short-term survival in recipients of marrow transplantation and patients with hematological malignancies

Abstract

Summary:Most hematogenous candidiasis originates from endogenous host flora. The impact of clinically prominent Candida colonization on short-term mortality (р14 weeks) was prospectively studied in 193 hospitalized patients from 1998 to 1999. Clinically prominent colonization included yeasts isolated from all sterile body sites and Ͼ50 colonies of Candida from non-sterile sites. Fourteen (7.1%) patients were granulocytopenic (ANC р100/ l). Nineteen (9.8%) had undergone marrow transplantation, 26 (13.5%) had a hematologic malignancy and 129 (66.5) had non-hematologic cancer. Candida isolates (216) were collected form 210 specimens. Fifty-three (27.5%) patients died; 25 (19.4%) with solid tumors, compared to 16 (61.5%) with hematological malignancy, and 11 (57.9%) BMT recipients (P Ͻ 0.001). No deaths were seen in patients with AIDS, and one (7.7%) in a patient with a benign condition (P Ͻ 0.001). Twenty-six (29.2%) patients with respiratory tract, 13 (23.2%) with gastrointestinal tract, and three (14.3%) with genitourinary tract colonization died. In patients with multiple-site colonization, mortality was significantly higher (45.5%) (P Ͻ 0.05). Mortality was higher in patients with C. glabrata (52.9%) and C. krusei (75%) colonization than with C. albicans (24.1%) (P Ͻ 0.025). This study shows that patients with hematologic cancer and recipients of marrow transplant with Candida colonization of multiple body sites, and colonization with C. glabata or C. krusei have poor survival. Bone Marrow Transplantation (2002) 30, 931-935.

A prospective analysis of the genotypic diversity and dynamics of the Candida albicans colonizing flora in neutropenic patients with de novo acute leukemia

“…14 However, a rise in colonization and bloodstream infections due to fluconazole-resistant species has been reported in neutropenic patients receiving fluconazole prophylaxis. [15][16][17] Furthermore, the emergence of C. albicans isolates with reduced susceptibility to fluconazole has been described in the course of long-term, low-dose exposure to fluconazole. 18 Interestingly in this context, molecular-relatedness studies have shown that multiple C. albicans sub-populations with distinct antifungal susceptibility patterns can coexist in patients with human immunodeficiency virus infection presenting with oral candidiasis.…”

Prospective, Multicenter Surveillance Study of Candida glabrata : Fluconazole and Itraconazole Susceptibility Profiles in Bloodstream, Invasive, and Colonizing Strains and Differences between Isolates from Three Urban Teaching Hospitals in New York City ( Candida Susceptibility Trends Study, 1998 to 1999)

“…The variations in the rates of antifungal susceptibility among C. glabrata isolates from patients at hospitals within a geographic area are not known, however. In addition, since systemic C. glabrata yeast infections frequently arise from the host's endogenous microflora, mainly that in the orointestinal and genitourinary tracts (21,25,26), we thought that it was important to assess the antifungal susceptibility profiles of both colonizing C. glabrata strains and those associated with systemic disease. During a 12-month period, C. glabrata organisms isolated from patients receiving treatment at three urban teaching hospitals in New York City were evaluated prospectively.…”

Dual Properties of Anticancer Agents: An Exploratory Study on the in vitro Anti-Candida Properties of Thirty Drugs

“…Moreover, an earlier report on bleomycin showed that in vitro activities do not always match in vivo activities [32]; hence, the results of our study need to be confirmed in an animal model. Neutropenic patients with advanced cancers and malignancies are at a high risk for developing invasive and superficial Candida infections [33,34]. Most of the time, C. albicans is associated with these infections and is a reason for the high mortality rates in cancer patients [35,36,37].…”