TY - JOUR
T1 - Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes
AU - Pagano, Livio
AU - Antinori, Andrea
AU - Ammassari, Adriana
AU - Mele, Luca
AU - Nosari, Annamaria
AU - Melillo, Lorella
AU - Martino, Bruno
AU - Sanguinetti, Maurizio
AU - Equitani, Francesco
AU - Nobile, Francesco
AU - Carotenuto, Mario
AU - Morra, Enrica
AU - Morace, Giulia
AU - Leone, Giuseppe
PY - 1999
Y1 - 1999
N2 - A retrospective study of 76 episodes of candidemia in 73 patients with underlying hematological malignancy, from 1998 until 1997, has been conducted to evaluate the clinical characteristics and to ascertain the variables related to the onset and the outcome of candidemia. The most frequent malignancy was acute myeloid leukemia (29 episodes). Candidemia developed mainly during aplasia in patients refractory to chemotherapy (42%). In 65 episodes (86%) the patients were neutropenic (ANC 9/l) before the candidemia diagnosis for a median time of 13 d, and in 53 episodes (70%) at microbiological diagnosis of candidemia ANC was 9/l. Candida albicans was the most frequently isolated etiologic agent (31 episodes), but C. non- albicans species sustained the majority of candidemia. Seventeen candidemias developed during azoles prophylaxis. One month after the diagnosis of candidema, 26 patients died. In 19 cases, death was attributable to candidemia. The case-control study demonstrated, at univariate analysis, that the colonization with Candida. spp. (p=0.004), antimycotic prophylaxis (p=0.01), presence of central venous catheter (p=0.01), neutropenia (p=0.002), and the use of glycopeptide (p=0.0001) increased the risk of candidemia. Using multivariate regression analysis only colonization with Candida spp. and the previous therapy with glycopeptide were associated with a significantly increased risk. Acute mortality, expressed by a cumulative probability of survival at 30 d from diagnosis of candidemia, was 0.67 (95% C.I. 0.55-0.77) and was significantly reduced in patients with neutrophils 9/l when compared to those with neutrophils > 1 x 109/l (p at Mantel- Cox=0.029). Overall cumulative probability of survival at 1 yr was 0.38 (95% C.I. 0.27-0.49) and only the treatment with Amfotericin B significantly reduced the risk of death.
AB - A retrospective study of 76 episodes of candidemia in 73 patients with underlying hematological malignancy, from 1998 until 1997, has been conducted to evaluate the clinical characteristics and to ascertain the variables related to the onset and the outcome of candidemia. The most frequent malignancy was acute myeloid leukemia (29 episodes). Candidemia developed mainly during aplasia in patients refractory to chemotherapy (42%). In 65 episodes (86%) the patients were neutropenic (ANC 9/l) before the candidemia diagnosis for a median time of 13 d, and in 53 episodes (70%) at microbiological diagnosis of candidemia ANC was 9/l. Candida albicans was the most frequently isolated etiologic agent (31 episodes), but C. non- albicans species sustained the majority of candidemia. Seventeen candidemias developed during azoles prophylaxis. One month after the diagnosis of candidema, 26 patients died. In 19 cases, death was attributable to candidemia. The case-control study demonstrated, at univariate analysis, that the colonization with Candida. spp. (p=0.004), antimycotic prophylaxis (p=0.01), presence of central venous catheter (p=0.01), neutropenia (p=0.002), and the use of glycopeptide (p=0.0001) increased the risk of candidemia. Using multivariate regression analysis only colonization with Candida spp. and the previous therapy with glycopeptide were associated with a significantly increased risk. Acute mortality, expressed by a cumulative probability of survival at 30 d from diagnosis of candidemia, was 0.67 (95% C.I. 0.55-0.77) and was significantly reduced in patients with neutrophils 9/l when compared to those with neutrophils > 1 x 109/l (p at Mantel- Cox=0.029). Overall cumulative probability of survival at 1 yr was 0.38 (95% C.I. 0.27-0.49) and only the treatment with Amfotericin B significantly reduced the risk of death.
KW - Candidemia
KW - Leukemia
UR - http://www.scopus.com/inward/record.url?scp=0032772819&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0032772819&partnerID=8YFLogxK
M3 - Article
C2 - 10480286
AN - SCOPUS:0032772819
VL - 63
SP - 77
EP - 85
JO - European Journal of Haematology
JF - European Journal of Haematology
SN - 0902-4441
IS - 2
ER -