Results of treatment for candidemia in patients with blood system tumors


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AIM: To study the etiology, clinical manifestations, risk factors, and results of treatment for candidemia (CE) in patients with blood system tumors/MATERIAL AND METHODS: The investigation included the patients with CE and hemoblastoses treated at the Hematology Research Center, Ministry of Health of the Russian Federation, in 2006 to 2012. The diagnosis of CE was established according to the single isolation of Candida spp. from blood cultures and the presence of infection symptoms/RESULTS: Over 7 years, CE was diagnosed in 57 patients aged 17 to 77 years (median age 48 years). Among the patients with CE, there was a preponderance of those with lymphomas (54%) and acute leukemias (30%). The pathogens of CE were C. albicans (33%), C. guilliermondii (26%), С. parapsilosis (12%), С. krusei (8%), C. lusitaniae (5%), С. famata (4%), C. tropicalis (4%), С. glabrata (4%), and C. pelliculosa (4%). The major risk factors were polychemotherapy (85%), granulocytopenia (63%), mucosal Candida spp. colonization (82%), the presence of central venous catheter (CVC) (97%), antibiotics (100%), and glucocorticosteroids (70%). The infection occurred with the intake of an antifungal agent in 33% of the patients; 60% had concomitant infections of other etiology. Antifungal agents were given to 52 (91%) patients. Within 30 days after CE diagnosis, 20 (35%) patients died; of them 12 (60%) patients showed tumor progression concurrent with the infection. The cure rate for CE was significantly higher in the use of echinocandin as a first-line drug (92%), in complete or partial remission in hemoblastosis (90%), CVC removal (76%) and in the administration of an antifungal drug on day 1 of detection of positive blood cultures (75%). The cure rate was significantly lower when septic shock developed and a patient was transferred to an intensive care unit (15%), when amphotericin B was used as a first-line drug (45%), when granulocytopenia occurred (53%), or glucocorticoids were given (55%)/CONCLUSION: Candida non-albicans constitute a high proportion among the pathogens of CE. A number of risk factors influencing survival rates in CE have been identified. It is crucial to use echinocandin as a first-line agent as soon as possible after isolation of Candida spp. from blood cultures.

About the authors

G A Kliasova

Гематологический научный центр Минздрава России, Москва

Email: klias@blood.ru
125167 Москва, Новый Зыковский пр-д, д. 4

E V Blokhina

Гематологический научный центр Минздрава России, Москва

A N Gracheva

Гематологический научный центр Минздрава России, Москва

S K Kravchenko

Гематологический научный центр Минздрава России, Москва

E N Parovichnikova

Гематологический научный центр Минздрава России, Москва

G M Galstian

Гематологический научный центр Минздрава России, Москва

References

  1. Клясова Г.А., Сперанская Л.Л., Миронова А.В., Масчан М.А. Возбудители сепсиса у иммунокомпрометированных больных: структура и проблемы антибиотикорезистентности (результаты многоцентрового исследования). Гематол и трансфузиол 2007; 1: 11-19.
  2. Tortorano A.M., Peman J., Bernhardt H. et al. Epidemiology of can-didaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study. Eur J Clin Microbiol Infect Dis 2004; 23 (4): 317-322.
  3. Wisplinghoff H., Bischoff T., Tallent S.M. et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39: 309-317.
  4. Arendrup M, Sulim S, Holm A. et al. Diagnostic issues, clinical characteristic, and outcomes for patients with candidemia. J Clin Microbiol 2011; 49: 3300-3308.
  5. De Pauw B., Walsh T., Donnelly P. et al. Revised definitions of invasive fungal disease from European organization for research and treatment of invasive fungal disease from European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group EORTC/MSG) consensus group. Clin Infect Dis 2008; 46: 1813-1821.
  6. Hachem R., Hanna H., Kontoyiannis D. et al. The changing epidemiology of invasive candidiasis: Candida glabrata and Candida krusei as the leading causes of candidemia in hematologic malignancy. Cancer 2008; 112 (11): 2493-2499.
  7. Arendrup M., Dzajic E., Johansen H. et al. National surveillance of fungemia in Denmark 2010-2011. M-318, 52nd Interscience Conference on Antimicrobial Agents Chemotherapy, 2012, San-Francisco, California, USA.
  8. Веселов А.В., Мултых И.Г., Клясова Г.А. и др. Эпидемиология возбудителей кандидозов и их чувствительность к азолам: результаты исследования ARTEMIS Disc в России. Клин микробиол антимикроб химиотер 2005; 7 (1): 4-31.
  9. Климко Н.Н., Богомолова Т.С., Колб З.К. и др. Кандидемии у пациентов в стационарах Санкт-Петербурга. Клин микробиол антимикроб химиотер 2002; 4: 15-21.
  10. Kliasova G., Mirinova A., Trushina E. et al. Epidemiology of Bacteremia in Hematological Patients: Results of Prospective Multicenter Study in Russia. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICCAC). San Francisco 2009: K-95.
  11. Sook-Bin W., Sonis S.T., Monopoli M.M., Sonis A.L. A longitudinal Study of Oral Ulcerative Mucositis in Bone Marrow Transplant Recipients. Cancer 1993; 72 (5): 1612-1617.
  12. Sipsas N.V., Lewis R.E., Tarrand J. Candidemia in Patients With Hematologic Malignancies in the Era of New Antifungal Agents (2001-2007). Cancer 2009; 4745-475.
  13. Andes D., Safdar N., Baddley J. et al. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis 2012; 54 (8): 1110-1122.
  14. Garey K.W., Rege M., Pai M.P. et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 2006; 43: 25-31.
  15. Hsu D., Nguyen M., Nguyen A., Law A. et al. A multicenter study to evaluate the impact of timing of caspofungin administration on outcomes of invasive candidiasis in non-immunocompromised patients. J Antimicrob Chemother 2010; 65: 1765-1770.
  16. Fresco G., Martin-Davilo P., Fortun J. et al. Emerging trends in candidemia by C. glabrata: a better outcome in a worse setting. Conference on Antimicrobial Agents and Chemotherapy (ICCAC), San Francisco 2012, M323.
  17. Ullmann A., Akova M., Herbrecht R. et al. ESCMID guidelines for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation. Clinical Microbiol Infec 2012; 18: 53-67.

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