NOSOCOMIAL BREAKTHROUGH FUNGEMIA DURING ANTIFUNGAL PROPHYLAXIS OR EMPIRICAL ANTIFUNGAL THERAPY IN 41 CANCER-PATIENTS RECEIVING ANTINEOPLASTIC CHEMOTHERAPY - ANALYSIS OF ETIOLOGY RISK-FACTORS AND OUTCOME

Forty-one episodes of breakthrough fungaemia occurring over a 7.5 year period in the National and St Elizabeth's Cancer Institutes in Bratis lava, Slovakia, were analysed. Five of them occurred during prophylaxi s with fluconazole tone Torulopsis glabrata, one Hansenula anomala, tw o Candida krusei and one Candida parapsilosis), ten with itraconazole (three Trichosporon pullulans, one Trichosporon beigelii, one Cryptoco ccus laurentii, three Candida albicans and two T. glabrata), 11 during prophylaxis with ketoconazole (one Candida norvegenesis, one C. parap silosis, one C. krusei, one Candida tropicalis, five C. albicans, one Candida stellatoidea and one C. laurentii and 15 during empirical ther apy with amphotericin B (ten C. albicans, two T. beigelii and three Ca ndida lusitaniae). The most frequent risk factors for breakthrough fun gaemia were neutropenia, previous therapy with multiple antibiotics an d recent catheter insertion. Comparing these episodes with 38 non-brea kthrough fungaemias (appearing at the same institute in the same perio d) differences in certain risk factors were noted: breakthrough fungae mias were more frequently observed in patients with acute leukaemia (3 9.0% vs 5.2%, P < 0.001), mucositis (34.2% vs 13.1%, P < 0.05), prophy laxis with quinolones (58.5% vs 15.8%, P < 0.0001) and catheter-associ ated infections (29.3% vs 2.6%, P < 0.003). In this subgroup overall m ortality (36.6% vs 28.8%) or early attributable mortality (22.0% vs 23 .6%) were not significantly different.