Candida parapsilosis fungemia in cancer patients - incidence, risk factorsand outcome

The paper presents an analysis of fungemia cases which were caused by C, pa rapsilosis in a cancer center within 10 years, with the aim to compare risk factors and the outcome with fungemias caused by C, albicans and other non -albicans Candida spp. fungemias. Before 1990 (1988-1989) in our institutes C.parapsilosis fungemias were not observed at all. During 1990-1997, the proportion of C.parapsilosis among fungemias increased, in 1990-1993 from 0% to 7.1% in 1996-1997 to 14.2-15%. It represents 25% out of non-albicans Candida spp. fungemias and 7.9% out of all fungemias and is the third commonest pathogen after C. albicans (50. 5%) and C.krusei (9.9%). Two from eight (25%) C.parapsilosis fungemias were breakthroughs, one appeared during prophylaxis with ketoconazol and one wi th fluconazol. Considering the proportion of C.parapsilosis among blood cul tures, 13 of 170 blood cultures contained C. parapsilosis (6.6% among all y easts from blood cultures). C.parapsilosis was the second commonest fungal organism isolated from blood cultures (after C, albicans) in our cancer cen ter. Infected vascular catheters were surprisingly not the major risk factor: ce ntral venous catheters were documented as a source in two cases only. The c ommonest risk factors were similar to those occurring with other fungemias - such as preceeding antimicrobial therapy (62.5%), neutropenia (50%) and p rior prophylaxis with azoles.