CANDIDEMIA IN ACUTE-LEUKEMIA PATIENTS

Fungal infections are an important cause of morbidity and mortality in patients with acute leukemia (AL). Candidemia, once rare, is now a co mmon nosocomial infection because of the intensity of chemotherapy, pr olonged neutropenia, administration of broad-spectrum antibiotics and use of central venous catheters (CVC). We retrospectively identified p atients treated for AL from 6/86 to 6/95 who also had candidemia. We d escribe 28 patients (incidence 6.3%) with a median age of 39 years, 24 of whom were on remission induction and 4 on postremission chemothera py. 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/mu l, median dura tion 19 days). Candida was isolated in blood cultures 10 days (median) after the start of neutropenia. The clinical presentation included fe ver (100%), respiratory symptoms (71.4%), skin lesions (39.2%) and sep tic shock (17.8%). Amphotericin B was given to 17 patients and liposom al amphotericin to 5 patients. Infection resolved in 18 patients (64.2 %), 10 of whom were in complete remission. Mortality from candidemia w as 17.8% (5/28). In conclusion, fungal infections are responsible for death in a significant number of patients. In our series treatment suc cess was related to its rapid onset and to the recovery of neutropenia .