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Open Access 01-05-2017 | Original

The risk and clinical outcome of candidemia depending on underlying malignancy

Authors: Olivier Lortholary, Charlotte Renaudat, Karine Sitbon, Marie Desnos-Ollivier, Stéphane Bretagne, Françoise Dromer, The French Mycoses Study Group

Published in: Intensive Care Medicine | Issue 5/2017

Abstract

Purpose

To assess the risk factors and outcomes associated with fungemia caused by the six most commonly occurring Candida species in patients with and without malignancies.

Methods

Analysis 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).

Results

Of 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.

Conclusion

The clinical context of underlying malignancy and hospitalization in ICU may be relevant to the initial management of candidemia.

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Title: The risk and clinical outcome of candidemia depending on underlying malignancy
Authors: Olivier Lortholary
Charlotte Renaudat
Karine Sitbon
Marie Desnos-Ollivier
Stéphane Bretagne
Françoise Dromer
The French Mycoses Study Group
Publication date: 01-05-2017
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 5/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-017-4743-y

At a glance: The STEP trials

Springer Medicine

The risk and clinical outcome of candidemia depending on underlying malignancy

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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