title: Early initiation of appropriate treatment is associated with increased survival in cancer patients with Candida glabrata fungaemia: a potential benefit from infectious disease consultation.
abstract: In patients with malignancies, Candida glabrata is one of the most frequent non-albicans Candida clinical isolates. As antifungal resistance in C. glabrata is common, we investigated the relationship between early appropriate antifungal treatment, infectious disease (ID) consultation and mortality in a contemporary cohort of cancer patients with C. glabrata fungaemia. We included patients with at least one C. glabrata-positive blood culture and symptoms or signs of infection seen at the MD Anderson Cancer Center between March 2005 and September 2013. In vitro susceptibility to antifungals was defined according to the 2010 CLSI clinical breakpoints. One-hundred and forty-six episodes of candidaemia were studied. Thirty isolates (20.5%) had fluconazole MIC ≥ 64 mg/L and 15 (10.3%) were caspofungin-resistant. Early (within 48 h after blood culture collection) initiation of appropriate antifungal treatment (hazard ratio 0.374, p 0.003) and early ID consultation (hazard ratio 0.421, p 0.004) were associated with decreased mortality, after adjustment for significant confounders. Thirty-two of 58 patients (55.2%) followed by ID were on appropriate antifungals within 48 h, compared with 16/88 patients (18.2%) who were not followed by ID an ID specialist (p <0.001). The median time-to-reporting of blood culture positivity for yeast was 71 h. Delayed time-to-reporting was associated with increased 28-day all-cause mortality (log-rank p 0.023). The benefits from early initiation of appropriate antifungal treatment and ID consultation were more prominent in patients with non-catheter-related candidaemia. In conclusion, in cancer patients with C. glabrata fungaemia, early ID consultation may lead to timely initiation of appropriate treatment and improved clinical outcomes.
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center Houston, TX, USA; Infectious Disease Section, Baylor College of Medicine Houston, TX, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Dimitrios
authors: D
authors: Farmakiotis
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center Houston, TX, USA.
authors: A
authors: A
authors: Kyvernitakis
authors: Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: J J
authors: JJ
authors: Tarrand
authors: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center Houston, TX, USA. Electronic address: dkontoyi@mdanderson.org.
authors: D P
authors: DP
authors: Kontoyiannis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D041221:Candida glabrata; D058387:Candidemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D055499:Catheter-Related Infections; D002648:Child; D005260:Female; D006801:Humans; D055552:Infectious Disease Medicine; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Antifungal resistance; Candida glabrata; cancer; candidaemia; infectious disease consultation