Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes

A retrospective study of 76 episodes of candidemia in 73 patients with unde rlying hematological malignancy, from 1988 until 1997, has been conducted t o evaluate the clinical characteristics and to ascertain the variables rela ted to the onset and the outcome of candidemia. The most frequent malignanc y was acute myeloid leukemia (29 episodes). Candidemia developed mainly dur ing aplasia in patients refractory to chemotherapy (42%). In 65 episodes (8 6%) the patients were neutropenic (ANC <1x10(9)/1) before the candidemia di agnosis for a median time of 13 d, and in 53 episodes (70%) at microbiologi cal diagnosis of candidemia ANC was <1x10(9)/1. Candida albicans was the mo st frequently isolated etiologic agent (31 episodes), but C. non-albicans s pecies sustained the majority of candidemia. Seventeen candidemias develope d during azoles prophylaxis. One month after the diagnosis of candidemia, 2 6 patients died. In 19 cases, death was attributable to candidemia. The cas e-control study demonstrated, at univariate analysis, that the colonization with Candida. spp. (p=0.004), antimycotic prophylaxis (p=0.01), presence o f central venous catheter p=0.01), neutropenia (p=0.002), and the use of gl ycopeptide (p=0.0001) increased the risk of candidemia. Using multivariate regression analysis only colonization with Candida spp. and the previous th erapy with glycopeptide were associated with a significantly increased risk . Acute mortality, expressed by a cumulative probability of survival at 30 d from diagnosis of candidemia, was 0.67 (95% C.I. 0.55-0.77) and was signi ficantly reduced in patients with neutrophils <1x10(9)/1 when compared to t hose with neutrophils >1x10(9)/1 (p at Mantel-Cox = 0.029). Overall cumulat ive probability of survival at 1 yr was 0.38 (95% C.I. 0.27-0.49) and only the treatment with Amfotericin B significantly reduced the risk of death.