Candidemia in acute leukemia patients
Abstract:
Fungal infections are an important cause of morbidity and mortality in patients with acute leukemia (AL). Candidemia, once rare, is now a common nosocomial infection because of the intensity of chemotherapy, prolonged neutropenia, administration of broad-spectrum antibiotics and use of central venous catheters (CVC). We retrospectively identified patients treated for AL from 6/86 to 6/95 who also had candidemia. We describe 28 patients (incidence 6.3%) with a median age of 39 years, 24 of whom were on remission induction and 4 on postremission chemotherapy. All patients had CVC and empiric antimicrobial therapy, 4 had been given prophylactic antifungal drugs, and 2 had parenteral nutrition. Neutropenia was profound (median leukocyte nadir 200/microliters, median duration 19 days). Candida was isolated in blood cultures 10 days (median) after the start of neutropenia. The clinical presentation included fever (100%), respiratory symptoms (71.4%), skin lesions (39.2%) and septic shock (17.8%). Amphotericin B was given to 17 patients and liposomal amphotericin to 5 patients. Infection resolved in 18 patients (64.2%). 10 of whom were in complete remission. Mortality from candidemia was 17.8% (5/28). In conclusion, fungal infections are responsible for death in a significant number of patients. In our series treatment success was related to its rapid onset and to the recovery of neutropenia.
Insights
Fungal infections, particularly candidemia, are a significant cause of death in acute leukemia (AL) patients. Early treatment and recovery from neutropenia improve survival rates in these vulnerable individuals.
Area of Science:
- Infectious Diseases
- Hematology
- Oncology
Background:
- Fungal infections pose a significant threat to patients with acute leukemia (AL).
- Candidemia has become a common nosocomial infection in AL patients due to intensive chemotherapy, prolonged neutropenia, broad-spectrum antibiotics, and central venous catheters (CVC).
Purpose of the Study:
- To retrospectively analyze the incidence, clinical presentation, treatment, and outcomes of candidemia in patients with acute leukemia.
Main Methods:
- Retrospective identification of 28 AL patients with candidemia between June 1986 and June 1995.
- Review of patient demographics, treatment regimens (including CVC, antimicrobial and antifungal therapies, parenteral nutrition), neutropenia status, clinical symptoms, and outcomes.
Main Results:
- The incidence of candidemia was 6.3% among AL patients.
- Patients experienced profound neutropenia (median 200 cells/microliter for 19 days).
- Common symptoms included fever (100%), respiratory issues (71.4%), skin lesions (39.2%), and septic shock (17.8%).
- Amphotericin B was the primary treatment.
- Infection resolved in 64.2% of patients, with 10 achieving complete remission.
- Mortality directly attributed to candidemia was 17.8%.
Conclusions:
- Fungal infections contribute significantly to mortality in acute leukemia patients.
- Prompt initiation of antifungal treatment and recovery of neutropenia are crucial for successful outcomes in candidemia.
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