Epidemiology and outcome of candidaemia in patients with oncological and haematological malignancies: results from a population-based surveillance in Spain

Abstract

A prospective, population-based surveillance on candidaemia was implemented in five metropolitan areas of Spain from May 2010 to April 2011. We aimed to describe the distribution and susceptibility pattern of Candida species, and to evaluate risk factors for mortality in patients with oncological (solid tumours) and haematological malignancies. Adults (≥ 16 years) with cancer were included in the present report. Impact of therapeutic strategies on 7- and 30-day mortality were analysed by logistic regression, adjusting for propensity score by inverse weighting probability of receiving early antifungal treatment and catheter removal. We included 238 (32.6%) patients (195 oncological, 43 haematological). Compared with oncological patients, haematological patients were more likely to have received chemotherapy (53.5% versus 17.4%, p < 0.001) or corticosteroids (41.9% versus 21%, p < 0.001), and have neutropenia (44.2% versus 1.5%, p < 0.001). Overall, 14.8% of patients developed breakthrough candidaemia. Non-albicans Candida species (71.1% versus 55.6%, p 0.056) and Candida tropicalis (22.2% versus 7.6%, p 0.011) were more frequent in haematological patients. Based on EUCAST breakpoints, 27.6% of Candida isolates were non-susceptible to fluconazole. Resistance to echinocandins was negligible. Mortality at 7 and 30 days was 12.2% and 31.5%, respectively, and did not differ significantly between the patient groups. Prompt antifungal therapy together with catheter removal (≤ 48 hours) was associated with lower mortality at 7 days (adjusted OR 0.05; 95% CI 0.01-0.42) and 30 days (adjusted OR 0.27; 95% CI 0.16-0.46). In conclusion, non-albicans species are emerging as the predominant isolates, particularly in haematological patients. Prompt, adequate antifungal treatment plus catheter removal may lead to a reduction in mortality.

Changing epidemiology of candidaemia: Increase in fluconazole‐resistant Candida parapsilosis

“…Candidaemia incidence in hospitalised population can vary greatly depending on geographical reasons, but similar increase overtime was recently described in a single centre in Belgium (1.48/10 000 patient‐days) and in regional collection in Lombardy ‐ Italy (1.59/10 000 patient‐days) . Such an increase in C parapsilosis has been also reported in several other centres worldwide, both in Southern Europe, namely in Italy and Spain, and in other regions such as in Serbia or South Africa …”

“…are the main cause of invasive fungal disease (IFD) in hospitalised patients and, in the early 2000s, it was the 4th pathogen causing sepsis in the United States and in Europe, with the candidaemia rate of 0.20‐0.38 cases per 1000 hospital admissions . Differences in the Candida species epidemiology have been reported according to different analysed factors such as setting, patients’ age or geographical location . Despite C albicans being the most frequently isolated species, accounting for almost 50% of all isolates in Italy and in Europe and 45.6% in United States, during the last decade a continuous increase in non‐ albicans species isolation has been observed …”

Clinical and microbiological characteristics, and impact of therapeutic strategies on the outcomes of children with candidemia

“…An incident episode of candidemia was defined as ≥1 positive blood culture drawn from a peripheral vein yielding a Candida isolate, with clinical symptoms and signs compatible with Candida BSI 2, 7, 16 . Episodes were considered to be separate if they occurred ≥1 month apart 21, 22 .…”

“…Candida bloodstream infection (BSI) is associated with high mortality and morbitidy rates among critically ill patients 1, 2 . The incidence of candidemia varies from 24 to 32.3 episodes/per 10,000 admissions 1, 3, 4 , and the mortality rate was 22–60% 2–6 .…”

“…The incidence of candidemia varies from 24 to 32.3 episodes/per 10,000 admissions 1, 3, 4 , and the mortality rate was 22–60% 2–6 . Recent strategies of antifungal prophylaxis or preemptive therapy for selected high-risk patients account for emergence of fluconazole resistant strains and an increased prevalence of non- albicans Candida species 7–9 .…”