Evaluation of candidemia in epidemiology and risk factors among cancer patients in a cancer center of China: an 8-year case-control study

Abstract

BackgroundCandidemia is the worldwide life-threaten disease, especially in cancer patients. This study was aimed to identify and evaluate the risk factors of candidemia in cancer patients, which will prompt the improvement on current therapeutic strategies and prognosis.MethodsA retrospective, case-control study was conducted from inpatients of Tianjin Medical University Cancer Institute and Hospital, during 2006 to 2013. Analyses were performed between cancer patients with candidemia as study case, and patients with bacterial bloodstream infections as control. Each case was matched up with two controls, for gender and inpatient duration. Candida species, clinical characteristics, risk factors and outcomes were reviewed in details.ResultsTotal number of 80 cases and 160 controls were enrolled and analyzed in this study. Candida albicans was identified as the most prevalent species and account for 55.0% candidemia, followed by Candida parapsilosis complex (21.3%), Candida tropicalis (8.8%), Candida glabrata complex (7.5%), Candida lusitaniae (3.8%), and Candida famata (3.8%). The crude mortality at 30-days of candidemia was up to 30.0%, which is significantly higher than bacterial bloodstream infections (p = 0.006). Logistical analysis demonstrated that total parenteral nutrition >5 days (p = 0.036), urinary catheter >2 days (p = 0.001), distant organ metastasis of cancer (p = 0.002) and gastrointestinal cancer (p = 0.042) were the independent risk factors for candidemia.ConclusionsCandidemia showed significant higher mortality than bacterial bloodstream infections, C. albicans was cited as the primary pathogen. Total parenteral nutrition, urinary catheter, distant organ metastasis of cancer and gastrointestinal cancer are independent predictors for candidemia, this findings provides potential therapeutic targets for improving the outcome.

Epidemiological features of nosocomial candidaemia in neonates, infants and children: A multicentre study in Iran

“…Overall, paediatric patients who are frequently exposed to high‐risk medications or have severe underlying diseases might be at risk of nosocomial candidaemia. We observed that patients with different types of cancer, that is haematological malignancies and/or non‐haematological malignancies (74.3%) because of their immunocompromised status, were much more susceptible to candidaemia than immunocompetent children, which corresponds with other studies . In fact, 78% of cancer patients received chemotherapy, corticosteroids, broad‐spectrum antibiotic therapy or prophylaxis, which was attributed to the observed high correlation of cancer with candidaemia.…”

“…The underlying diseases and risk factors for candidaemia in the various age groups of paediatric patients are different . For instance, as shown in the current study, prematurity, CVC use, mechanical ventilation, broad‐spectrum antibiotic therapy or prophylaxis, receipt of TPN, and long stay at the ICU were the major predisposing factors for neonatal candidaemia, whereas cancer, CVC use, chemotherapy, corticosteroid therapy and antifungal and antibiotic therapy or prophylaxis accounted for most of the candidaemia among infants and children.…”

“…We observed that patients with different types of cancer, that is haematological malignancies and/or non-haematological malignancies (74.3%) because of their immunocompromised status, were much more susceptible to candidaemia than immunocompetent children, which corresponds with other studies. 4,6,20 In fact, 78% of cancer patients received chemotherapy, corticosteroids, broad-spectrum antibiotic therapy or prophylaxis, which was attributed to the observed high correlation of cancer with candidaemia. In agreement with other reports, most patients examined in the current study had established healthcare-associated risk factors for the development of candidaemia, such as indwelling CVC (97%, P = 1), mechanical ventilation (40%; P < .0001) and TPN (32%; P < .0001) when the blood culture was obtained.…”

“…This indicates that healthcare-associated risk factors are a good predictor of positive blood culture. 6,14,[19][20][21][22][23][24][25] Strikingly, invasive candidiasis caused by non-albicans Candida species has only been reported in the past two decades. 22 Nonalbicans Candida species have emerged as agents of candidaemia, with an overall decreased incidence rate of C. albicans from 70% to 50% in developed countries.…”

Candida Tropicalis renal microabscesses in a child with leukemia confirmed using nucleic acid amplification and recovery after prolonged antifungal and corticosteroid treatment

“…Disseminated Candidal infections can occur in immunocompromised hosts such as patients receiving chemotherapy for malignancies, and Candida tropicalis may be involved in approximately 8% of cancer cases (Li et al, 2017). Culture of fungal abscess using traditional media may have low yield if the specimen is collected after antifungal therapy.…”