Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxison incidence and outcome

Candidemia is a serious complication in patients following allogeneic blood , marrow, and organ transplantation. Fourteen patients developed nosocomial fungemia among 204 allogeneic marrow transplants performed during 1997-199 9. Incidence of hematogenous candidiasis was 6.8 per 100 allogeneic BMT. Al l 14 had an indwelling central venous catheter (CVC) and fluconazole (100-2 00 mg daily) was given prophylactically. In 11 (78.5%) neutropenic patients , duration between agranulocytosis and diagnosis of fungemia was (median, /- s.d.) 10 +/- 8 days. Candida glabrata (53.3%) was the most common yeast species, followed by C. krusei (33.3%), and C. parapsilosis (13.3%). Candid a albicans was conspicuously absent. Ten patients (71.4%) had primary trans plant-related complication (>2 days) including hemolytic uremic syndrome/th rombotic thrombocytopenic purpura (HUS/TTP) (n = 5), severe hemorrhagic cys titis (n = 3), and bacteremia (n = 2). Seven (50.0%) patients expired and i n three (21.4%) deaths were attributed to fungemia. The impact of a primary transplant-related complication on short-term survival in this setting was not significant (P = 0.07) (HUS/TTP (P > 0.5); neutropenia (P > 0.5); GVHD (P = 0.35)). Removal of CVC did not alter outcome in our group (P greater than or equal to 0.5) although in patients with persistent fungemia (> 72 h ), and those with preceding bacteremia, mortality was significantly higher (P = 0.002). Conventional prognosticators of poor outcome did not adversely effect short-term survival in our transplant recipients with hematogenous candidiasis. The predominance of C. glabrata and C. krusei breakthrough inf ections was similar to what is seen with high-dose fluconazole (400 mg) pro phylaxis, and no adverse effects of low-dose fluconazole in terms of increa sed incidence of non-susceptible Candida species was seen.