gms | German Medical Science

Objectives: Candidemia is a common and life threatening complication for patients with hematological malignancy or solid tumors. Fluconazole has been recommended for hematological patients with an expected prolonged duration of neutropenia. In a previous investigation we could demonstrate a high rate of non-albicans Candida species in cancer patients with candida blood stream infection at our center, which may be a result of extended administration of azole prophylaxis. In 2009 a more restrictive recommendation for prophylaxis has been established. Here we analyze the impact of the local guideline on epidemiology of Candida BSI.

Methods: In this retrospective single center observational study the incidence of candidemia, species distribution and treatment resistance were investigated among other parameters. All patients with isolation of Candida species from blood culture since 2003 were identified through a database. Information about treatment of infection, previous antifungal prophylaxis, underlying disease, survival on day 30 and day 100 after the first Candida positive blood culture were retrieved from patient charts. Study parameters were analyzed by descriptive statistics and calculating frequency distributions for the time periods before 2009 and between 2010 and 2012. Statistical analyses were performed by SPSS 21.

Results: Between 2003 and 2012, 44 patients with Candida bloodstream infections have been identified. Forty-nine Candida species have been isolated (in 5 patients two different species were detected). The number of patients with candidemia has been below 3 between 2003 and 2007, 5 in 2008 and 8, 7, 7 and 10 in the following years. Candida albicans was identified in 40.8% of all cases in the whole time period, with 28.6% of the cases between 2003 and 2009 and 66.7% of the cases between 2010 and 2012. C. glabrata was the causal pathogen in 2 and 5 and C. krusei in 3 and 0 patients in the same time periods. All Candida albicans species were sensible for fluconazole. The underlying disease was acute leukemia in 8 and 9 patients, other hematological malignancy in 6 and 5 patients, solid tumor in 6 and 6 patients and other diseases in 0 and 4 patients between 2003 and 2009 and between 2010 and 2012, retrospectively. Rate of prophylaxis and outcome for patients receiving an echinocandin for first line antifungal therapy or not was not significant different. 60.7% of the patients with Candida BSI were alive on day 30.

Conclusion: In this single center investigation a changed recommendation for fluconazole prophylaxis did result in a trend to a higher proportion of fluconazole susceptible C. albicans isolates.