PROSPECTIVE-STUDY OF CANDIDA COLONIZATION, USE OF EMPIRIC AMPHOTERICIN-B AND DEVELOPMENT OF INVASIVE MYCOSIS IN NEUTROPENIC PATIENTS

The association between colonization with Candida spp., subsequent occ urrence of invasive candidiasis and empiric use of amphotericin B was investigated prospectively in 139 neutropenic patients with hematologi c malignancies. Treatment with amphotericin B was required in 67 % of patients colonized in multiple non-contiguous body sites (multicoloniz ed) versus 31 % of patients colonized in single or contiguous sites (m onocolonized) and in 21 % of non-colonized patients (p = 0.0037 and p = 0.00026, respectively). Invasive candidiasis was documented in 22.2 % of multicolonized versus 4.8 % of monocolonized patients and in none of the non-colonized patients (p = 0.035 and p = 0.0036, respectively ). Analysis of the spectrum of colonizing Candida spp. showed that mul ticolonized subjects were colonized with increased frequency by Candid a albicans compared to monocolonized subjects, and that the associatio n between multicolonization, invasive candidiasis and amphotericin B u sage was statistically significant in patients colonized by Candida al bicans but not in patients colonized by other Candida species. The ass ociation between Candida multicolonization and the occurrence of Candi da infection seems to be confirmed by a double-blind placebo-controlle d study performed in a small subgroup of the multicolonized patients t reated with fluconazole.