European Confederation of Medical Mycology (ECMM) prospective survey of candidaemia: report from one Italian region

Candidaemia in patients with haematological disorders and stem cell transplant

“…In addition, relapsing, untreated and refractory primary disease is an important associated factor for the development of fungaemia [25]. The predominant clinical manifestations of candidaemia are: fever, skin lesions, respiratory symptoms and septic shock [12,15,20]. In our study, the main predisposing factors for the development of fungaemia were: malignant haematological disorders specially AML, broad spectrum antibiotics, central venous catheters, neutropenia, cytotoxic chemotherapy, coexisting bacterial infection and steroid therapy.…”

“…The predisposing factors for candidaemia include: malignant haematological disorders specially AML, stem cell and solid organ transplantation, intensive cytotoxic chemotherapy, prolonged neutropenia, intravascular catheters, steroid therapy, broad spectrum antibiotic treatment, antifungal prophylaxis with fluconazole, bacteremia, cytomegalovirus disease, hospitalization and admission to intensive care units, HIV infection, surgical intervention and fetal immaturity [5,12,13,15,[18][19][20][21]. Gastrointestinal colonization by Candida species has also been found to play a major role in the development of breakthrough candidaemia [5,8,15,[22][23][24]. In addition, relapsing, untreated and refractory primary disease is an important associated factor for the development of fungaemia [25].…”

“…The frequency of non-albicans Candida species as causes of bloodstream isolates and their susceptibilities to fluconazole, vary considerably among different countries worldwide [8,17,26,27]. Fungaemia, due to these organisms, carries high mortality rates in immunocompromised individuals, especially in patients with leukaemia, solid tumors and hepatic disorders [8,15,17,21,26,27]. As with reports of increased prevalence of non-albicans species of Candida in neutropenic patients, our study showed predominance of non-albicans species particularly C. krusei and C. tropicalis.…”

“…In patients with fungaemia, poor prognosis and high mortality rates are associated with: severe underlying illness, old age, prolonged neutropenia, culture of non-albicans species of Candida, septic shock, visceral dissemination and lack of antifungal prophylaxis [2,15,33]. The early recognition of candidaemia, the prompt removal of central venous catheters and the early initiation of an appropriate antifungal therapy improve the outcome of patients with candidaemia [15,34].…”

“…Polymerase chain reactions (PCR) and antigen detection tests are useful in making an early diagnosis of candidaemia [13,14]. Successful management of candidaemia depends upon the early institution of antifungal therapy, the recovery of neutrophilic count and the early removal of intravascular catheters if present [12,15,16].…”