Risk factors and predictors of outcome in patients with cancer and breakthrough candidemia

Hematogenous candidiasis adds substantially to the morbidity and mortality rates of patients with cancer. Little is known about the risk factors and o utcome in patients with breakthrough (BT) candidemia while on systemic anti fungal therapy. All 479 episodes of candidemia in 474 consecutive patients with candidemia that was diagnosed at M. D. Anderson Cancer Center from 198 8 through 1992 were studied retrospectively. A total of 49 patients had BT candidemia, defined as candidemia that developed after at least 5 days of s ystemic antifungal therapy. Risk factors for BT candidemia and predictors o f mortality were investigated. Multivariate analysis revealed that intensiv e care unit stay, neutropenia, use of corticosteroids, and duration of neut ropenia as significant risk factors for BT candidemia. Seventy-six percent of patients with BT candidemia died, compared with 50% of patients with non -BT infection. In multivariate analysis, intensive care unit stay, being an d remaining neutropenic, APACHE III score, and disseminated disease were in dependent prognostic factors. In conclusion, identification of risk factors and predictors of a poor outcome in patients with cancer with BT candidemi a may have important implications in early diagnosis and appropriate therap y of these patients.