Abstract
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 1997–1999. Incidence of hematogenous candidiasis was 6.8 per 100 allogeneic BMT. All 14 had an indwelling central venous catheter (CVC) and fluconazole (100–200 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%). Candida albicans was conspicuously absent. Ten patients (71.4%) had primary transplant-related complication (>2 days) including hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) (n = 5), severe hemorrhagic cystitis (n = 3), and bacteremia (n = 2). Seven (50.0%) patients expired and in 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 ⩾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 infections was similar to what is seen with high-dose fluconazole (400 mg) prophylaxis, and no adverse effects of low-dose fluconazole in terms of increased incidence of non-susceptible Candida species was seen. Bone Marrow Transplantation (2001) 28, 873–878.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Louria DB, Blevins A, Armstrong D et al. Fungemia caused by ‘nonpathogenic’ yeasts Arch Intern Med 1967 119: 247–252
Meunier-Carpentier F, Kiehn TE, Armstrong D . Fungemia in the immunocompromised host. Changing patterns, antigenemia, high mortality Am J Med 1981 71: 363–370
Viscoli C, Girmenia C, Marinus A et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC) Clin Infect Dis 1999 28: 1071–1079
Beck-Sague C, Jarvis WR . Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980–1990. National Nosocomial Infections Surveillance System J Infect Dis 1993 167: 1247–1251
Verfaillie C, Weisdorf D, Haake R et al. Candida infections in bone marrow transplant recipients Bone Marrow Transplant 1991 8: 177–184
Uzun O, Ascioglu S, Anaissie EJ, Rex JH . Risk factors and predictors of outcome in patients with cancer and breakthrough candidemia Clin Infect Dis 2001 32: 1713–1717
Alangaden G, Chandrasekar PH, Bailey E et al. Antifungal prophylaxis with low-dose fluconazole during bone marrow transplantation. The Bone Marrow Transplantation Team Bone Marrow Transplant 1994 14: 919–924
Slavin MA, Osborne B, Adams R et al. Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation – a prospective, randomized, double-blind study J Infect Dis 1995 171: 1545–1552
Marr KA, Seidel K, Slavin MA et al. Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients: long-term follow-up of a randomized, placebo-controlled trial Blood 2000 96: 2055–2061
Wingard JR, Merz WG, Rinaldi MG et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole New Engl J Med 1991 325: 1274–1277
Wingard JR, Merz WG, Rinaldi MG et al. Association of Torulopsis glabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients Antimicrob Agents Chemother 1993 37: 1847–1849
Hoppe JE, Klausner M, Klingebiel T et al. Retrospective analysis of yeast colonization and infections in paediatric bone marrow transplant recipients Mycosis 1997 40: 47–54
Chandrasekar PH, Gatny CM . The effect of fluconazole prophylaxis on fungal colonization in neutropenic cancer patients. Bone Marrow Transplantation Team J Antimicrob Chemother 1994 33: 309–318
Marr KA, White TC, van Burik JA et al. Development of fluconazole resistance in Candida albicans causing disseminated infection in a patient undergoing marrow transplantation Clin Infect Dis 1997 25: 908–910
Safdar A, Armstrong D . Infections in patients with neoplastic diseases. In: Shoemaker WC, Grenvik M, Ayers SM, Holbrook PR (eds) Textbook of Critical Care, 4th edn Saunders: Philadelphia 2000 pp 715–726
Bodey GP, Anaissie EJ, Edwards JE . Definitions of Candida infections. In: Bodey GP (ed.) Candidiasis: Pathogenesis, Diagnosis, and Treatment Raven Press: New York 1993 pp 407–408
Nguyen MH, Peacock JE Jr, Morris AJ et al. The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance Am J Med 1996 100: 617–623
Abi-Said D, Anaissie E, Uzun O et al. The epidemiology of hematogenous candidiasis caused by different Candida species Clin Infect Dis 1997 24: 1122–1128
Abbas J, Bodey GP, Hanna HA et al. Candida krusei fungemia: an escalating serious infection in immunocompromised patients Arch Intern Med 2000 160: 2659–2664
Henslee-Downey JP, Abhyankar SH, Parrish RS et al. Use of partially mismatched related donors extends access to allogeneic marrow transplant Blood 1997 89: 3864–3872
Wey SB, Mori M, Pfaller MA et al. Hospital-acquired candidemia. The attributable mortality and excess length of stay Arch Intern Med 1988 148: 2642–2645
Pittet D, Wenzel RP . Nosocomial bloodstream infections. Secular trends in rates, mortality, and contribution to total hospital deaths Arch Intern Med 1995 155: 1177–1184
Wenzel RP . Nosocomial candidemia: risk factors and attributable mortality Clin Infect Dis 1995 20: 1531–1534
Pittet D, Li N, Woolson RF et al. Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model Clin Infect Dis 1997 24: 1068–1078
Vu Van H, Piens MA, Archimbaud E et al. Serum levels of ketoconazole in bone marrow transplanted patients Nouv Rev Franc Hematol 1983 25: 241–244
Winston DJ, Chandrasekar PH, Lazarus HM et al. Fluconazol prophylaxis of fungal infection in patients with acute leukemia: results of randomized placebo-controlled, double-blind, multicenter trial Ann Intern Med 1993 118: 495–503
Goodman JL, Winston DJ, Greenfield RA et al. A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation New Engl J Med 1992 326: 845–851
Wingard JR . Importance of Candida species other than C. albicans as pathogens in oncology patients Clin Infect Dis 1995 20: 115–125
Viscoli C, Castagnola E . Emerging fungal pathogens, drug resistance and the role of lipid formulations of amphotericin B in the treatment of fungal infections in cancer patients: a review Int J Infect Dis 1998 3: 109–118
Safdar A, Chaturvedi V, Cross EW et al. Prospective study of Candida species in patients at a comprehensive cancer center Antimicrob Agents Chemother 2001 45: 2129–2133
Wingard JR . Importance of Candida species other than C. albicans as pathogens in oncology patients Clin Infect Dis 1995 20: 115–125
Alexander BD, Perfect JR . Antifungal resistance trends towards the year 2000. Implications for therapy and new approaches Drugs 1997 54: 657–678
Safdar A, Perline D, Armstrong D . Impact of Candida species colonization on mortality in patients with cancer Clin Microbiol Infect 2001 7 (Suppl.1): 336 (Abstr. 1555)
Safdar A, Perlin DS, Armstrong D . Emergence of Candida parapsilosis fungemia as the dominant non-albicans Candida species bloodstream infection at a cancer center in New York Clin Microbiol Infect 2001 7: (Suppl. 1) 336 (Abstr. 1554)
Krcmery V Jr, Sejnova D, Pichnova E . Breakthrough Candida tropicalis fungemia during ketoconazole prophylaxis in cancer patients Acta Oncologica 1999 38: 663–665
Girmenia C, Martino P, De Bernardis F et al. Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects, predisposing factors, and differential pathogenicity of the causitive strains Clin Infect Dis 1996 23: 506–514
Lopez-Jimenez J, Duarte-Palomino R, Cabezudo E et al. Candida parapsiolosis fungemia in bone marrow transplantation recipients: implications for azole prophylactic therapy Blood 1997 89: 3491–3492
Goodman M, Pottage JC, Weaver DC . Candida krusei fungemia: report of four cases and review of the literature Medicine 1993 72: 143–150
Acknowledgements
The results of this study were presented in part at the Eleventh International Symposium on Infections in the Immunocompromised Host of The International Immunocompromised Host Society (ICHS), Halifax, Nova Scotia, June 2000.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Safdar, A., van Rhee, F., Henslee-Downey, J. et al. Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxis on incidence and outcome. Bone Marrow Transplant 28, 873–878 (2001). https://doi.org/10.1038/sj.bmt.1703252
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1703252
Keywords
This article is cited by
-
Impact of antifungal stewardship interventions on the susceptibility of colonized Candida species in pediatric patients with malignancy
Scientific Reports (2021)
-
Initial fluconazole prophylaxis may not be required in adults with acute leukemia or myelodysplastic/myeloproliferative disorders after reduced intensity conditioning peripheral blood stem cell allogeneic transplantation
Annals of Hematology (2015)
-
Weekly use of fluconazole as prophylaxis in haematological patients at risk for invasive candidiasis
BMC Infectious Diseases (2014)
-
Evaluation of intravenous voriconazole in patients with compromised renal function
BMC Infectious Diseases (2013)
-
Candida glabrata
Der Hautarzt (2012)