title: Epidemiology of candidemia in patients with hematologic malignancies and solid tumours in Brazil.
abstract: Candidemia in cancer patients may differ according to the type of cancer. To characterise the epidemiology and outcome of candidemia in cancer patients from Brazilian hospitals, we compared the characteristics of patients with hematologic malignancies (HM) and solid tumours (ST). A retrospective study was performed, based on data collected from laboratory-based surveillance studies in 18 tertiary care hospitals between March/2003 and December/2007. The characteristics of patients with HM (n = 117) were compared with patients with ST (n = 248). Predictors of 30-day mortality were identified by uni- and multivariate analyses. Candidemia in HM was more likely to occur in the setting of chemotherapy, corticosteroids, neutropenia, mucositis and tunnelled central venous catheter (CVC), whereas surgery, intensive care unit admission and invasive procedures (mechanical ventilation, parenteral nutrition and CVC) were more frequent in ST. The 30-day mortality rate was higher in the ST group (65% vs. 46%, P = 0.001). Factors significantly associated with 30-day mortality were older age and intensive care unit admission. Important differences in the epidemiology and outcome of candidemia in HM and ST were observed. The characterisation of the epidemiology is important to drive preventive measures and to select appropriate therapies.
authors.affiliation: Special Laboratory of Mycology, Infectious Diseases Division, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: M D
authors.initials: MD
authors.lastname: Bergamasco
authors.forename: M
authors.initials: M
authors.lastname: Garnica
authors.forename: A L
authors.initials: AL
authors.lastname: Colombo
authors.forename: M
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002175:Candida / Q000302:isolation & purification* / Q000472:pathogenicity; D058387:Candidemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000382:microbiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B