Treatment of candidemia caused by Candida albicans and Candida non - albicans in patients with hematological malignancies


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Abstract

Aim. To study the risk factors, symptoms and outcomes of candidemia caused by C. albicans and C. non - albicans in patients with hematological malignancies. Materials and methods. The study included patients with hematological malignancies and candidemia. The diagnosis of candidemia was established according to the single isolation of Candida spp. from blood culture and the presence of symptoms of infection. Results and discussion. Over 12 years (2006-2017), candidemia was diagnosed in 75 patients aged 17 to 77 years (median 48 years). The causative agents of candidemia were C. albicans in 34.7% of patients, C. non - albicans - in 65.3%. Candidemia caused by C. albicans prevailed in patients of the older age group (median 56.5 years, p=0.04) and in patients with lymphoma (61.5%, p=0.01) with colonization of the gut by the same species of Candida (88.5%, p=0.002). Isolation of C. non - albicans from blood culture was more common in patients with acute leukemia (51%, p=0.01) and in recipients of allogeneic hematopoietic stem cells (22.5%, p=0.01). The ability to form biofilms was observed more frequently among C. non - albicans (59.2%) than C. albicans (19.2%, p=0.001). The clinical symptoms of candidemia were non - specific (fever was in 97%). Septic shock developed in 25 (33%) patients with comparable frequency in both groups. Concomitant infections was also comparable (73% vs. 73.5%). Overall 30-day survival in patients with candidemia caused by C. albicans and C. non - albicans was 61.2% and 61.5%. Treatment with echinocandin was associated with increase of survival compared to other antifungal agents among patients with C. albicans candidaemia (88.9% versus 40%, p=0.02) and among C. non - albicans (77.3% versus 47.8%). Conclusion. C. non - albicans constituted a high proportion among causative agents of candidemia. High mortality rate was observed in both groups. Initial therapy with echinocandin was associated with increase of survival.

About the authors

G A Klyasova

National Research Center for Hematology

Email: klyasova.g@blood.ru
д.м.н., проф., врач клинический фармаколог, зав. лаб. клинической бактериологии, микологии и антибиотической терапии ФГБУ «НМИЦ гематологии»; e-mail: klyasova.g@blood.ru; ORCID: 0000-0001-5973-5763 Moscow, Russia

A O Malchikova

National Research Center for Hematology

аспирант научно-клинической лаборатории клинической бактериологии, микологии и антибиотической терапии ФГБУ «НМИЦ гематологии»; ORCID: 0000-0002-8725-5131 Moscow, Russia

K S Tandilova

National Research Center for Hematology

аспирант научно-клинической лаборатории клинической бактериологии, микологии и антибиотической терапии ФГБУ «НМИЦ гематологии»; ORCID: 0000-0003-3414-9316 Moscow, Russia

E V Blohina

Sechenov First Moscow State Medical University (Sechenov University)

ассистент каф. госпитальной терапии №1 лечебного факультета ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Moscow, Russia

E N Parovichnikova

National Research Center for Hematology

д.м.н., руководитель отд. высокодозной химиотерапии гемобластозов, депрессий кроветворения и трансплантации костного мозга ФГБУ «НМИЦ гематологии»; ORCID: 0000-0001-6177-3566 Moscow, Russia

S K Kravchenko

National Research Center for Hematology

к.м.н., зав. отд-нием химиотерапии гематологических заболеваний и интенсивной терапии ФГБУ «НМИЦ гематологии»; ORCID: 0000-0001-7026-1706 Moscow, Russia

V G Savchenko

National Research Center for Hematology

д.м.н., проф., академик РАН, ген. директор ФГБУ «НМИЦ гематологии»; ORCID: 0000-0001-8188-5557 Moscow, Russia

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