Candida glabrata fungemia in a tertiary cancer institution in Slovakia

Because of controversial data on virulence and mortality, six cases of fungemia caused by Candida glabrata were reviewed in a single cancer institution within 8 years. Risk factors and outcome of C. glabrata, Candida albicans, and other non-albicans Candida spp. appearing within the same period under the same antibiotic policy at the same institution were compared. Among other non-albicans Candida spp. in 1990-1997 C. glabrata fungemias showed a decreasing tendency, from 9% to 4.5% in 1997. Analyzing the proportion of C. glabrata among blood cultures, among 170 positive blood cultures 12 were caused by C. glabrata (6.2% among all pathogens and 24% among non-albicans Candida spp.). C. glabrata among all fungemias was diagnosed as the fourth most common pathogen after C. albicans, C. krusei, and C. parapsilosis. Three of six C. glabrata fungemias were breakthrough. Two appeared during prophylaxis with itraconazole and one during fluconazole prophylaxis. Five of six received broadspectrum antibiotic therapy with third-generation cephalosporines, five of six had vascular catheter insertion, four of six were neutropenic, and two of six received amphotericin B therapy. One patient died before his blood cultures were reported to be positive. Overall mortality of C. glabrata fungemia was 16.7%. One patient died of underlying disease with fungemia. There were no significant differences in risk factors between C. glabrata and C. albicans. However, overall and crude mortality was lower in C. glabrata than in C. albicans (25.5% vs. 16.7%; P = 0.03). Attributable mortality was lower in comparison to C. albicans (0 vs. 15.7% in C. albicans; P = 0.001).