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Candida krusei fungemia. An escalating serious infection in immunocompromised patients
J Abbas1, G P Bodey, H A Hanna
1The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
Background:
Candida krusei is inherently resistant to fluconazole and is emerging as a frequent cause of fungemia in patients with hematologic malignant neoplasms.
Objective:
To determine the risk and prognostic factors associated with C krusei fungemia in comparison with Candida albicans fungemia in patients with cancer.
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 krusei cases were compared with 57 cases of C albicans fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Evaluation II score, immunosuppression status, chemotherapy, and the use of central 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 krusei fungemia more often had leukemia than patients with C albicans (77% vs 11%; P =.02), whereas catheter-related infections were more common among patients 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 they more frequently were neutropenic and had disseminated infection. Mortality related to fungemia was 49% in the cases with C krusei vs 28% in C albicans. Multiple logistic regression analysis showed that persistent neutropenia (P =.02) and septic shock (P =.002) were predictors of poor prognosis.
Conclusion:
In neutropenic patients, C krusei fungemia is associated with high mortality. It should be suspected in patients with leukemia who are receiving fluconazole prophylaxis and should be treated aggressively with an amphotericin B regimen.
Insights
Candida krusei fungemia is a growing concern in cancer patients, especially those with leukemia and neutropenia. Aggressive treatment with amphotericin B is recommended due to high mortality rates.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Hematology Oncology
Background:
- Candida krusei exhibits inherent resistance to fluconazole.
- Emerging as a significant cause of fungemia in patients with hematologic malignancies.
Purpose of the Study:
- Determine risk and prognostic factors for Candida krusei fungemia.
- Compare these factors with Candida albicans fungemia in cancer patients.
Main Methods:
- Retrospective study of 57 Candida krusei fungemia cases (1989-1996).
- Comparison with 57 Candida albicans fungemia cases.
- Analysis of demographics, cancer type, severity scores, immunosuppression, chemotherapy, catheter use, and fluconazole prophylaxis.
Main Results:
- Candida krusei fungemia increased from 5% to 10% of cases during the study period.
- Patients with C. krusei more often had leukemia (77% vs 11%) and lower response rates (51% vs 69%).
- Higher mortality (49% vs 28%) for C. krusei, with neutropenia and septic shock as poor prognostic predictors.
Conclusions:
- Candida krusei fungemia in neutropenic patients is linked to high mortality.
- Suspect C. krusei in leukemia patients on fluconazole prophylaxis.
- Recommend aggressive treatment with amphotericin B regimens.