Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes

Citation
L. Pagano et al., Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes, EUR J HAEMA, 63(2), 1999, pp. 77-85
Citations number
39
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology,"Cardiovascular & Hematology Research
Journal title
EUROPEAN JOURNAL OF HAEMATOLOGY
ISSN journal
0902-4441 → ACNP
Volume
63
Issue
2
Year of publication
1999
Pages
77 - 85
Database
ISI
SICI code
0902-4441(199908)63:2<77:RSOCIP>2.0.ZU;2-U
Abstract
A retrospective study of 76 episodes of candidemia in 73 patients with unde rlying hematological malignancy, from 1988 until 1997, has been conducted t o evaluate the clinical characteristics and to ascertain the variables rela ted to the onset and the outcome of candidemia. The most frequent malignanc y was acute myeloid leukemia (29 episodes). Candidemia developed mainly dur ing aplasia in patients refractory to chemotherapy (42%). In 65 episodes (8 6%) the patients were neutropenic (ANC <1x10(9)/1) before the candidemia di agnosis for a median time of 13 d, and in 53 episodes (70%) at microbiologi cal diagnosis of candidemia ANC was <1x10(9)/1. Candida albicans was the mo st frequently isolated etiologic agent (31 episodes), but C. non-albicans s pecies sustained the majority of candidemia. Seventeen candidemias develope d during azoles prophylaxis. One month after the diagnosis of candidemia, 2 6 patients died. In 19 cases, death was attributable to candidemia. The cas e-control study demonstrated, at univariate analysis, that the colonization with Candida. spp. (p=0.004), antimycotic prophylaxis (p=0.01), presence o f central venous catheter p=0.01), neutropenia (p=0.002), and the use of gl ycopeptide (p=0.0001) increased the risk of candidemia. Using multivariate regression analysis only colonization with Candida spp. and the previous th erapy with glycopeptide were associated with a significantly increased risk . Acute mortality, expressed by a cumulative probability of survival at 30 d from diagnosis of candidemia, was 0.67 (95% C.I. 0.55-0.77) and was signi ficantly reduced in patients with neutrophils <1x10(9)/1 when compared to t hose with neutrophils >1x10(9)/1 (p at Mantel-Cox = 0.029). Overall cumulat ive probability of survival at 1 yr was 0.38 (95% C.I. 0.27-0.49) and only the treatment with Amfotericin B significantly reduced the risk of death.