Failure of systemic empirical treatment with amphotericin B to prevent candidemia in neutropenic patients with cancer.
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.
Blumberg
E A
EA
Department of Medicine, Medical College of Pennsylvania and Hahnemann University School of Medicine, Philadelphia, USA.
Reboli
A C
AC
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy* / Q000469:parasitology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000469:parasitology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000469:parasitology; D012189:Retrospective Studies; D017211:Treatment Failure
D000666:Amphotericin B