Candidemia in Nonneutropenic Patients with an Intravenous Hyperalimentation Catheter: Good Prognosis of Candida parapsilosis Infection

Abstract

Positive blood cultures reported between 1986 and 1993 at the Tokyo Metropolitan Komagome Hospital were evaluated and all patients with an intravenous hyperalimentation catheter who developed candidemia, a total of 94 patients, were analyzed further, while patients with neutropenia were excluded. The primary diagnosis was malignancy in 87.2% of the cases, and Candida albicans and C. parapsilosis were the main organisms detected. A total of 17 patients died from candidemia. The patients who were positive for C. parapsilosis, however, all survived in spite of the fact that their main treatment was only removal of the catheter (20/32 cases), while eight of 25 patients who developed fungemia due to C. albicans died from the fungemia (p = 0.001). There were no significant differences in their risk factors. Because of the better outcome for the patients who developed candidemia due to C. parapsilosis, we might be able to consider less aggressive treatment for such patients.

Prognostic factors of candidemia among nonneutropenic adults with total parenteral nutrition

“…31 Some patients survived in spite of the fact that their main treatment was only removal of the catheter. However, this phenomenon was not observed in our study.…”

Changes in Clinical Features of Fungemia in a Japanese University Hospital over a 12-Year Period.

“…In our study, age was not a prognostic factor in surgical patients; mean age (y) ± SD was 58.0 ± 13.8 (n=5) in the group who died with 14 days after the isolation of fungus, and 57.5 ± 19.2 (n=16) in the group who survived more than 14 days. Some reports (10,16,27) showed that the prognosis was better in patients positive for C. parapsilosis than for those positive for C. albicans. This was also likely in our study; only two out of nine patients with C. parapsilosis died within 14 days after the isolation of fungus.…”

Amino acids mediate colony and cell differentiation in the fungal pathogen Candida parapsilosis

“…Relevant to the current study, most outbreaks of candidaemia in neonatal intensive care units around the world are associated with hyperalimentation (Chowdhary et al, 2003;Kataoka et al, 1995;Lee et al, 1998;Leibovitz et al, 1992;Levy et al, 1998;MacDonald et al, 1998;Sherertz et al, 1992;Shian et al, 1993;Shin et al, 2002). Interestingly, the hyperalimentation regimen contains amino acids at concentrations far higher than those required to induce hyphal differentiation.…”