Pronostic factors for survival in candidemia among onco-hematology patients: a single-center retrospective study during 10 years

Candidemias are increasing due to an aging and immunocompromised population. The objective of our study is to analyze survival, prognostic factors, and describe the characteristics of candidemias among onco-hematological patient. We conducted a retrospective monocentric study identifying candidemia with at least one positive yeast blood culture among patients with hematological malignancy from January, 1,2010 to December, 31, 2021. We included 135 patients. Mostly lymphoma (47%) and acute leukemia (39%) were the two major disease groups. An active disease was found in 93 patients (69%). Candida albicans (50%) was the most commonly isolated species. Mortality at 30 days after the candidemia was 44% (60/135), reaching 63% (43/68) among patients admitted to the intensive care unit. In the multivariate analysis, severe sepsis (adjusted OR 3.13; 95 % CI 1.09-9.42) and active disease (adjusted OR 4.00; 95% CI 1.41-11.33) were significantly associated with 30-day mortality while acute renal failure (adjusted OR 2.93 95% CI 0.98-8.73) was close to significance. We observed 24 breakthrough infections, with Pichia kudriavzevii being the predominant species among them. The non susceptibility rates to fluconazole and caspofungin were 15.5% (21/135) and 12% (16/135), respectively in the overall population, while reaching 54% (14/24) and 36% (8/24) in the breakthrough infection subgroup. Candidemias in onco-hematology patients are associated with significant mortality. Severe sepsis, active disease, and acute renal failure are adverse prognostic factors at 30 days. Evolving epidemiology of candidemia necessitate prospective monitoring of candidemia epidemiology to adjust prophylaxis. In case of breakthrough infection, we recommend liposomal amphotericin B or voriconazole.