Mortality associated with candidemia in non-neutropenic cancer patients is not less compared to a neutropenic cohort of cancer patients

Goel, Gaurav; Chandy, Mammen; Bhattacharyya, Arpita; Banerjee, Sudeep; Chatterjee, Sanjoy; Mullick, Sudakshina; Sinha, Subir; Sengupta, Kasturi; Dhar, Kingshuk; Bhattacharya, Sanjay; Rudramurthy, Shivaprakash M.; Chakrabarti, Arunaloke

doi:10.1007/s10096-017-3078-5

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…A total of 5 fungal strains (9.70%) were detected in our center, all of which were Candida tropicalis, which was higher than that reported by Goel et al [19] in 6140 ALL patients (32 cases, 0.52%). Fungemia was identi ed in only 5 cases, which might have been underestimated since isolation of fungus from blood culture usually has lower yield.…”

Section: Discussioncontrasting

confidence: 63%

Incidence and Risk Factors of Infection during Induction Phase of Treatment without Preventive Antibiotics and Antifungal in Pediatric Acute Lymphoblastic Leukemia: A Retrospective Cohort Study from a Single Center in China

liu,

Fu,

Wang

et al. 2024

Preprint

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Background Children with acute lymphoblastic leukemia (ALL) are highly susceptible to infections due to active leukemia and chemotherapy-induced immunosuppression during the induction phase. Knowledge on the incidence, impact and outcome of infection in children during the induction phase of treatment without prophylactic antibiotics and antifungals is currently limited. Methods The clinical data of pediatric patients with newly diagnosed ALL at Qilu Hospital of Shandong University between January 1, 2015 and December 31, 2019 were reviewed and analyzed. Results Of the 377 children in the retrospective cohort, 237 developed 259 episodes of infections in different sites. The most common infections were respiratory tract infections followed by fever of unknown origin. A total of 65 microbial strains were detected, including 39 strains of Gram-positive (G+) bacteria, 17 strains of Gram-negative (G−) bacteria, five strains of fungi and four strains of viruses. Staphylococcus was the predominant genera of G+ bacteria, whereas Pseudomonas aeruginosa was the common genera of G− bacteria. There were significant differences between infection and time from symptom onset to diagnosis (≤ 15d or > 15d), duration of granular deficiency (≥ 15d or < 15d), and whether protective isolation was given in laminar beds (P < 0.05). Of the 237 episodes of infections, 45 patients had delayed CAM chemotherapy and seven patients died. Conclusion Abnormal bone marrow hematopoiesis and high incidences of infection, hemorrhage, and anemia were present in pediatric patients during the induction phase. In addition, infection-related morbidity, mortality, and chemotherapy delay remain clinically significant.

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Section: Discussioncontrasting

confidence: 63%

Incidence and Risk Factors of Infection during Induction Phase of Treatment without Preventive Antibiotics and Antifungal in Pediatric Acute Lymphoblastic Leukemia: A Retrospective Cohort Study from a Single Center in China

liu,

Fu,

Wang

et al. 2024

Preprint

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“…Whereas one study found a positive blood culture for Candida spp. in 32 out of 6140 pediatric and adult cancer patients [ 18 ], Candida spp. was not isolated in any blood culture of the present analysis.…”

Section: Discussionmentioning

confidence: 99%

Infections during Non-Neutropenic Episodes in Pediatric Cancer Patients—Results from a Prospective Study in Two Major Large European Cancer Centers

et al. 2022

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Whereas the clinical approach in pediatric cancer patients with febrile neutropenia is well established, data on non-neutropenic infectious episodes are limited. We therefore prospectively collected over a period of 4 years of data on all infectious complications in children treated for acute lymphoblastic or myeloid leukemia (ALL or AML) and non-Hodgkin lymphoma (NHL) at two major pediatric cancer centers. Infections were categorized as fever of unknown origin (FUO), and microbiologically or clinically documented infections. A total of 210 patients (median age 6 years; 142 ALL, 23 AML, 38 NHL, 7 leukemia relapse) experienced a total of 776 infectious episodes (571 during neutropenia, 205 without neutropenia). The distribution of FUO, microbiologically and clinically documented infections, did not significantly differ between neutropenic and non-neutropenic episodes. In contrast to neutropenic patients, corticosteroids did not have an impact on the infectious risk in non-neutropenic children. All but one bloodstream infection in non-neutropenic patients were due to Gram-positive pathogens. Three patients died in the context of non-neutropenic infectious episodes (mortality 1.4%). Our results well help to inform clinical practice guidelines in pediatric non-neutropenic cancer patients presenting with fever, in their attempt to safely restrict broad-spectrum antibiotics and improve the quality of life by decreasing hospitalization.

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“…Patients suffering from fungaemia are complex and might have multiple underlying disorders and predisposing factors [1,19,52]. Episodes of MF are also more common in patients with multiple underlying pathologies or predisposing factors (Table 2, Supplementary Material Table S1).…”

Section: Discussionmentioning

confidence: 99%

Mixed fungaemia: an 18-year report from a tertiary-care university hospital and a systematic review

Gülmez

Alp

Gürsoy

et al. 2020

Clinical Microbiology and Infection

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Background: While fungaemia caused by two or more different species of yeasts (mixed fungaemia, MF) is infrequent, it might be underestimated. Aims: This study aimed to determine the incidence of MF, clinical characteristics of the patients, and antifungal susceptibility profiles of the isolates with a systematic review of the literature. Sources: Data sources were PubMed and Scopus. Study eligibility criteria: Studies reporting ten or more mixed fungaemia episodes. Content: Study included MF episodes in adults between January 2000 and August 2018 in Hacettepe University Hospitals, Turkey. The isolation, identification and antifungal susceptibility testing (AFST) of the isolates were by standard mycological methods. Patient data were obtained retrospectively. Literature search was performed using relevant keywords according to PRISMA systematic review guidelines. A total of 32 patients with 33 MF episodes were identified. Among all fungaemia episodes, MF incidence was 3.7% (33/883). All patients had one or more underlying disorders among which solid-organ cancer (50.0%, 16/32) was the most common. Overall mortality was 51.5% (17/33). The most preferred antifungal agents for initial treatment were fluconazole (48.5%, 16/33) and echinocandins (39.4%, 13/33). Fluconazole susceptible-dose-dependent (S-DD) or -resistant Candida species were detected in 15 episodes, and an isolate of C. parapsilosis was classified as S-DD by AFST. All Candida isolates were susceptible to echinocandins. Non-candida yeasts with intrinsic resistance/reduced susceptibility to both echinocandins and fluconazole were detected in two episodes. Systematic review of the literature revealed 24 studies that reported more than ten MF episodes. Methodology was variable. Improvement of detection rates was reported when chromogenic agars were used. Most studies underlined detection of isolates with reduced susceptibility. Implications: Although rare, the MF rate is affected by the detection methods, which have improved in recent years. Fluconazole and echinocandins were used for initial treatment in accordance with the current guideline recommendations; however, isolates non-susceptible to both were detected. Detection of a mixed infection offers an opportunity for optimum treatment.

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Mortality associated with candidemia in non-neutropenic cancer patients is not less compared to a neutropenic cohort of cancer patients

Cited by 8 publications

References 5 publications

Incidence and Risk Factors of Infection during Induction Phase of Treatment without Preventive Antibiotics and Antifungal in Pediatric Acute Lymphoblastic Leukemia: A Retrospective Cohort Study from a Single Center in China

Incidence and Risk Factors of Infection during Induction Phase of Treatment without Preventive Antibiotics and Antifungal in Pediatric Acute Lymphoblastic Leukemia: A Retrospective Cohort Study from a Single Center in China

Infections during Non-Neutropenic Episodes in Pediatric Cancer Patients—Results from a Prospective Study in Two Major Large European Cancer Centers

Mixed fungaemia: an 18-year report from a tertiary-care university hospital and a systematic review

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