Background: Candida krusei is inherently resistant to fluconazole and is em
erging as a frequent cause of fungemia in patients with hematologic maligna
Objectives: To determine the risk and prognostic factors associated with C
krusei fungemia in comparison with Candida albicans fungemia in patients wi
Methods: Retrospective study of 57 cases of C krusei fungemia occurring at
the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C kr
usei cases were compared with 57 cases of C albicans fungemia with respect
to demographics, underlying cancer, Acute Physiology and Chronic Health Eva
luation II score, immunosuppression status, chemotherapy, and the use of ce
ntral venous catheters, as well as fluconazole prophylaxis.
Results: At our institution, C krusei accounted for 5% of fungemias during
1989 through 1992 and for 10% during 1993 through 1996. Patients with C kru
sei fungemia more often had leukemia than patients with C albicans (77% vs
11%; P=.02), whereas catheter-related infections were more common among pat
ients with C albicans fungemia (42% vs 0%; P<.001). Patients with C krusei
fungemia had a lower response rate (51% vs 69%; P=.05), largely because the
y more frequently were neutropenic and had disseminated infection. Mortalit
y related to fungemia was 49% in the cases with C krusei vs 28% in C albica
ns. Multiple logistic regression analysis showed that persistent neutropeni
a (P=.02) and septic shock (P=.002) were predictors of poor prognosis.
Conclusion: In neutropenic patients, C krusei fungemia is associated with h
igh mortality. It should be suspected in patients with leukemia who are rec
eiving fluconazole prophylaxis and should be treated aggressively with an a
mphotericin B regimen.