Related Experiment Video
Updated: Mar 6, 2026
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
The risk and clinical outcome of candidemia depending on underlying malignancy
Olivier Lortholary1,2, Charlotte Renaudat3, Karine Sitbon3
1Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France. olivier.lortholary@pasteur.fr.
Purpose:
To assess the risk factors and outcomes associated with fungemia caused by the six most commonly occurring Candida species in patients with and without malignancies.
Methods:
Analysis of the episodes of fungemia due to common Candida species in adults, based on an active hospital-based surveillance program (Paris area, France, 2002 to 2014).
Results:
Of the 3417 patients (3666 isolates), 1164 (34.1%) had a solid tumor (45.7% digestive tract) and 586 (17.1%) a hematological malignancy (41.8% lymphoma, 33.5% acute leukemia). The hematology patients were significantly younger, more often pre-exposed to antifungals, more often infected by C. tropicalis, C. krusei, or C. kefyr, and more often treated in the first instance with an echinocandin. Compared with inpatients who were not in ICU at the time of fungemia, those in ICU were less frequently infected by C. parapsilosis (p < 0.02), had more recent surgery (p < 0.03), and died more frequently before day 8 and day 30 (p < 0.0001). An increase in crude mortality over time in ICU was observed only in oncology patients (p < 0.04). For all patients, lack of prescription of antifungals despite knowledge of positive blood culture increased the risk of death. The odds of being infected by a given Candida species compared with C. albicans were uneven regarding age, gender, type of malignancy, hospitalization in ICU, central venous catheter, HIV status, intravenous drug addiction, and previous exposure to antifungal drugs. Compared with C. albicans, C. glabrata (OR = 0.69 [0.54-0.89]) and C. parapsilosis (OR = 0.49 [0.35-0.67]) were associated with a decreased risk of death by day 8 and day 30.
Conclusion:
The clinical context of underlying malignancy and hospitalization in ICU may be relevant to the initial management of candidemia.
Insights
Fungal infections (fungemia) in cancer patients have different risk factors and outcomes. Candidemia management should consider malignancy and ICU stay, as some Candida species are linked to lower mortality.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Oncology
Background:
- Fungemia, particularly candidemia, poses a significant threat in healthcare settings.
- Understanding the specific risk factors and outcomes associated with different Candida species is crucial for effective patient management.
- Malignancy is a known risk factor for invasive fungal infections.
Purpose of the Study:
- To evaluate risk factors and outcomes of fungemia caused by common Candida species.
- To compare these factors in patients with and without malignancies.
Main Methods:
- A hospital-based surveillance program in the Paris area (2002-2014) analyzed fungemia episodes.
- Data from 3417 adult patients with 3666 Candida isolates were examined.
- Risk factors, species distribution, and outcomes were assessed, considering patient demographics and clinical characteristics.
Main Results:
- Malignancy was present in 34.1% (solid tumors) and 17.1% (hematological) of patients.
- Hematology patients were younger, more often received antifungals, and were infected by specific Candida species (C. tropicalis, C. krusei, C. kefyr).
- Intensive care unit (ICU) patients had higher mortality rates and different species prevalence (less C. parapsilosis). Lack of antifungal prescription increased death risk. Candida glabrata and Candida parapsilosis infections were associated with lower mortality compared to Candida albicans.
Conclusions:
- The presence of malignancy and ICU hospitalization are key factors influencing candidemia management.
- Tailoring initial treatment strategies based on these clinical contexts is recommended.
- Further research into species-specific outcomes can refine antifungal therapy.
Related Concept Videos
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:21Cancer Survival Analysis
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:19Psychoneuroimmunology: Diabetes and Cancer