Failure of Systemic Empirical Treatment with Amphotericin B to Prevent Candidemia in Neutropenic Patients with Cancer

Abstract

We undertook a retrospective review of all patients with hematologic malignancies in whom candidemia developed during chemotherapy-induced neutropenia in 1989 and 1990. Candidemia developed in 11 patients; five were receiving therapeutic doses of amphotericin B at the time of infection. Disseminated infection occurred in 2 of 5 patients with breakthrough infection and 3 of 6 patients with candidemia before receipt of amphotericin B. Among patients with breakthrough candidemia there was a trend toward more-prolonged neutropenia prior to infection (P = .069), but otherwise they were indistinguishable from other candidemic patients with regard to risk factors for candidemia. Amphotericin B-susceptible Candida albicans was isolated from two patients and Candida krusei from three patients with breakthrough infection. All patients were treated with amphotericin B; all breakthrough infections responded to treatment. Neutropenic patients with breakthrough candidemia were clinically similar to those whose candidemia preceded amphotericin B therapy, and there was no increase in morbidity and mortality among individuals with breakthrough infection.

Analysis of factors related to the occurrence of chronic disseminated candidiasis in patients with acute leukemia in a non-bone marrow transplant setting

“…9,10 Therefore, efforts have been directed toward investigating risk factors that predispose patients with acute leukemia undergoing BMT or chemotherapy to candidal infections. [11][12][13] In the current study, we examined clinical, laboratory, and treatment features related to the occurrence of CDC in non-BMT recipients. The variables examined were proposed by several investigators as being risk factors for the development of CDC in patients with acute leukemia.…”

Nosocomial fungemia due to amphotericin B-resistant Candida spp. in three pediatric patients after previous neurosurgery for brain tumors

“…Concerning etiology, it was assumed that AmB resistance appearred only in C. lusitaniae and C. guillermondii. 1,[13][14][15][16] However, as seen from Table 2, practically all species of Candida may develop secondary AmBresistance. In our three patients, each infection was caused by a different species (C. lusitaniae, C. parapsilosis, C. guillermondii).…”

“…In addition, several strains of Trichosporon spp., and probably a large number of Fusarium spp., are primarily resistant to AmB. 15,16 Therefore, not only rapid speciation but also susceptibility testing of isolates from blood or CSF cultures is mandatory, and should be done immediately (not only in cases of clinical failure), because the mortality of fungemia is still unacceptably high.…”

Single-Dose AmBisome (Liposomal Amphotericin B) as Prophylaxis for Murine Systemic Candidiasis and Histoplasmosis

“…Since empiric antifungal therapy should also be broad spectrum, intravenous amphotericin B (0.5 to 0.6 mg/ kg/day) has usually been administered in this setting (16). Despite this, breakthrough fungal infections have been reported even in patients receiving 0.6 to 1.0 mg of empiric amphotericin B per kg per day (6,20).…”