title: Breakthrough candidemia in patients with cancer differs from de novo candidemia in host factors and Candida species but not intensity.
abstract: OBJECTIVE
  To evaluate the risk factors associated with breakthrough candidemia in patients with cancer and to compare them with those of de novo candidemia in this patient population.
  
  
  METHODS
  Retrospective case series of 120 episodes of candidemia, 90 de novo and 30 breakthrough candidemias.
  
  
  METHODS
  University-affiliated, tertiary-care cancer center in Houston, Texas.
  
  
  METHODS
  All patients with cancer who acquired candidemia between January 1993 and December 1998 were included if they had non-catheter-related candidemia and information about quantitative blood cultures.
  
  
  RESULTS
  Although less frequent, breakthrough candidemia was seen more often in neutropenic patients with leukemia. The intensity of breakthrough candidemia was comparable to that of de novo candidemia. Most (70%) of the breakthrough candidemias were due to Candida glabrata or C. krusei.
  
  
  CONCLUSIONS
  In breakthrough candidemia, the same risk factors seen in de novo candidemia were encountered, although more frequently. C. glabrata and C. krusei are the leading causes of breakthrough candidemia in patients with cancer.
authors.affiliation: Department of Infectious Diseases, Infection Control & Employee Health, The University of Texas MD. Anderson Cancer Center, Houston 77030, USA.
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Bhavanandra T
authors.initials: BT
authors.lastname: Reddy
authors.forename: Hend
authors.initials: H
authors.lastname: Hanna
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Bodey
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tarrand
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D002176:Candida albicans; D041221:Candida glabrata; D041022:Candida tropicalis; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology*; D002648:Child; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000209:etiology*; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000097:blood / Q000150:complications; D009504:Neutrophils; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology