Predictors of adverse outcome in cancer patients with candidemia.
BACKGROUND
Many factors, including severity of illness, neutropenia, intravenous catheter management, and drug therapy may affect the outcome of candidemia in cancer patients.


METHODS
The records of all patients at M. D. Anderson Cancer Center who developed one or more positive blood cultures for Candida spp between January 1, 1988, and December 31, 1992, were retrospectively reviewed. Four hundred ninety-one episodes of candidemia were identified, for which 476 had complete medical records, which were reviewed in detail.


RESULTS
By 3-month follow-up, 52% of the patients had died. Neutropenia, higher APACHE III score, and visceral dissemination were associated with poor prognosis. Cure rates, adjusted for severity of illness, were similar for fluconazole and amphotericin B treatment. Exchange of central venous catheters was associated with a modest improvement in prognosis.


CONCLUSIONS
Several factors that influence the outcome of candidemia in cancer patients have been identified. These factors may be relevant for the clinical management of cancer patients with candidemia, and for the design of therapeutic trials.
Anaissie
E J
EJ
Department of Medical Specialties, M. D. Anderson Cancer Center, University of Texas Medical School, Houston, USA.
Rex
J H
JH
Uzun
O
O
Vartivarian
S
S
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000935:Antifungal Agents / Q000627:therapeutic use; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy; D005260:Female; D016469:Fungemia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000935:Antifungal Agents