Etiology of candidemia in patients with solid tumors - 7 years of experience of one oncology center

 Maria Szymankiewicz, Tomasz Nowikiewicz

Abstract:

Although the candidemia still remains a serious health problem, the study of candidemia in cancer patients is limited. We conducted a retrospective analysis of candidemia among 31 adult patients hospitalized in one oncological center. The mean annual incidence of candidemia was 0.14±0.05/1000 patient-days (range 0.04-0.91). In 10 patients (32.3%), the catheter-related infection was diagnosed; in the remaining 21 patients (67.7%), it was a secondary infection. From 31 patients of candidemia, 15 died (48.4% 30-day mortality), but an overall mortality rate during hospital stay was 61.3% (19 cases). Patients with secondary candidemia, ASA=IV and complicated postoperative course, had poorer 1-year survival probability compared with patients with catheter-related infection (p=0.004), ASA<IV (p=0.0393), and uncomplicated postoperative course (p=0.0009). C. glabrata (n=13, 41.9%) was the most frequently isolated species, followed by C. albicans (n=12, 38.7%) and C. parapsilosis (n=3, 9.7%). C. lusitaniae (n=2, 6.5%), and C. tropicalis (n=1, 3.2%) were sporadically isolated. Within C. glabrata, there was no resistance to anidulafungin, two strains (15.4%) were resistant to fluconazole, while the others showed intermediate susceptibilities to this drug. A total of 58.0% of all Candida spp. strains were sensitive to fluconazole, and 90.0% of the strains were sensitive to anidulafungin. Mortality in candidemia among patients with solid tumors undergoing surgery remains high. The complicated postoperative course requiring reoperation and secondary origin of candidemia are factors for poor prognosis. The demonstrated dominant role of C. glabrata in inducing candidemia is becoming a serious clinical and therapeutic problem.