Candida krusei fungemia - An escalating serious infection in immunocompromised patients

Background: Candida krusei is inherently resistant to fluconazole and is em erging as a frequent cause of fungemia in patients with hematologic maligna nt neoplasms. Objectives: To determine the risk and prognostic factors associated with C krusei fungemia in comparison with Candida albicans fungemia in patients wi th cancer. Methods: Retrospective study of 57 cases of C krusei fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C kr usei cases were compared with 57 cases of C albicans fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Eva luation II score, immunosuppression status, chemotherapy, and the use of ce ntral venous catheters, as well as fluconazole prophylaxis. Results: At our institution, C krusei accounted for 5% of fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients with C kru sei fungemia more often had leukemia than patients with C albicans (77% vs 11%; P=.02), whereas catheter-related infections were more common among pat ients with C albicans fungemia (42% vs 0%; P<.001). Patients with C krusei fungemia had a lower response rate (51% vs 69%; P=.05), largely because the y more frequently were neutropenic and had disseminated infection. Mortalit y related to fungemia was 49% in the cases with C krusei vs 28% in C albica ns. Multiple logistic regression analysis showed that persistent neutropeni a (P=.02) and septic shock (P=.002) were predictors of poor prognosis. Conclusion: In neutropenic patients, C krusei fungemia is associated with h igh mortality. It should be suspected in patients with leukemia who are rec eiving fluconazole prophylaxis and should be treated aggressively with an a mphotericin B regimen.