title: A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies.
abstract: Invasive candidiasis is a life-threatening infection in patients with haematological malignancies. The objective of our study was to determine the incidence, microbiological characteristics and clinical outcome of candidaemia among hospitalized adult patients with haematological malignancies. This is a population-based, prospective, multicentre study of patients ≥ 18 years admitted to haematology and/or haematopoietic stem cell transplantation units of nine tertiary care Greek hospitals from January 2009 through to February 2012. Within this cohort, we conducted a nested case-control study to determine the risk factors for candidaemia. Stepwise logistic regression was used to identify independent predictors of 28-day mortality. Candidaemia was detected in 40 of 27,864 patients with haematological malignancies vs. 967 of 1,158,018 non-haematology patients for an incidence of 1.4 cases/1000 admissions vs. 0.83/1000 respectively (p <0.001). Candidaemia was caused predominantly (35/40, 87.5%) by non-Candida albicans species, particularly Candida parapsilosis (20/40, 50%). In vitro resistance to at least one antifungal agent was observed in 27% of Candida isolates. Twenty-one patients (53%) developed breakthrough candidaemia while receiving antifungal agents. Central venous catheters, hypogammaglobulinaemia and a high APACHE II score were independent risk factors for the development of candidaemia. Crude mortality at day 28 was greater in those with candidaemia than in control cases (18/40 (45%) vs. 9/80 (11%); p <0.0001). In conclusion, despite antifungal prophylaxis, candidaemia is a relatively frequent infection associated with high mortality caused by non-C. albicans spp., especially C. parapsilosis. Central venous catheters and hypogammaglobulinaemia are independent risk factors for candidaemia that provide potential targets for improving the outcome.
authors.affiliation: Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece; Weill Cornell Medical Center of Cornell University, New York, NY, USA.
authors.forename: M N
authors.initials: MN
authors.lastname: Gamaletsou
authors.forename: T J
authors.initials: TJ
authors.lastname: Walsh
authors.forename: T
authors.initials: T
authors.lastname: Zaoutis
authors.forename: M
authors.initials: M
authors.lastname: Pagoni
authors.forename: M
authors.initials: M
authors.lastname: Kotsopoulou
authors.forename: M
authors.initials: M
authors.lastname: Voulgarelis
authors.forename: P
authors.initials: P
authors.lastname: Panayiotidis
authors.forename: T
authors.initials: T
authors.lastname: Vassilakopoulos
authors.forename: M K
authors.initials: MK
authors.lastname: Angelopoulou
authors.forename: M
authors.initials: M
authors.lastname: Marangos
authors.forename: A
authors.initials: A
authors.lastname: Spyridonidis
authors.forename: D
authors.initials: D
authors.lastname: Kofteridis
authors.forename: A
authors.initials: A
authors.lastname: Pouli
authors.forename: D
authors.initials: D
authors.lastname: Sotiropoulos
authors.forename: P
authors.initials: P
authors.lastname: Matsouka
authors.forename: A
authors.initials: A
authors.lastname: Argyropoulou
authors.forename: S
authors.initials: S
authors.lastname: Perloretzou
authors.forename: K
authors.initials: K
authors.lastname: Leckerman
authors.forename: A
authors.initials: A
authors.lastname: Manaka
authors.forename: P
authors.initials: P
authors.lastname: Oikonomopoulos
authors.forename: G
authors.initials: G
authors.lastname: Daikos
authors.forename: G
authors.initials: G
authors.lastname: Petrikkos
authors.forename: N V
authors.initials: NV
authors.lastname: Sipsas
mesh_terms: D000293:Adolescent; D000328:Adult; D000361:Agammaglobulinemia / Q000188:drug therapy; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000145:classification*; D058387:Candidemia / Q000453:epidemiology* / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D016022:Case-Control Studies; D062905:Central Venous Catheters / Q000009:adverse effects; D005260:Female; D006115:Greece / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Candidaemia; haematological malignancy; incidence; outcome; risk factors