title: Epidemiology and outcome of fungemia in a cancer Cohort of the Infectious Diseases Group (IDG) of the European Organization for Research and Treatment of Cancer (EORTC 65031).
abstract: BACKGROUND
  Anti-cancer treatment and the cancer population have evolved since the last European Organisation for Research and Treatment of Cancer (EORTC) fungemia survey, and there are few recent large epidemiological studies.
  
  
  METHODS
  This was a prospective cohort study including 145 030 admissions of patients with cancer from 13 EORTC centers. Incidence, clinical characteristics, and outcome of fungemia were analyzed.
  
  
  RESULTS
  Fungemia occurred in 333 (0.23%; 95% confidence interval [CI], .21-.26) patients, ranging from 0.15% in patients with solid tumors to 1.55% in hematopoietic stem cell transplantation recipients. In 297 evaluable patients age ranged from 17 to 88 years (median 56 years), 144 (48%) patients were female, 165 (56%) had solid tumors, and 140 (47%) had hematological malignancies. Fungemia including polymicrobial infection was due to: Candida spp. in 267 (90%), C. albicans in 128 (48%), and other Candida spp. in 145 (54%) patients. Favorable overall response was achieved in 113 (46.5%) patients by week 2. After 4 weeks, the survival rate was 64% (95% CI, 59%-70%) and was not significantly different between Candida spp. Multivariable logistic regression identified baseline septic shock (odds ratio [OR] 3.04, 95% CI, 1.22-7.58) and tachypnoea as poor prognostic factors (OR 2.95, 95% CI, 1.66-5.24), while antifungal prophylaxis prior to fungemia (OR 0.20, 95% CI, .06-.62) and remission of underlying cancer (OR, 0.18; 95% CI, .06-.50) were protective.
  
  
  CONCLUSIONS
  Fungemia, mostly due to Candida spp., was rare in cancer patients from EORTC centers but was associated with substantial mortality. Antifungal prophylaxis and remission of cancer predicted better survival.
authors: Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne Department I of Internal Medicine, University Hospital Cologne Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, and German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
authors: Oliver A
authors: OA
authors: Cornely
authors: Institut Gustave Roussy Département de Soins Aigus, Institut Gustave-Roussy, Villejuif, France.
authors: Bertrand
authors: B
authors: Gachot
authors: Ankara University School of Medicine, Turkey.
authors: Hamdi
authors: H
authors: Akan
authors: Santa Maria Misericordia Hospital, Udine, Italy.
authors: Matteo
authors: M
authors: Bassetti
authors: Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey.
authors: Omrun
authors: O
authors: Uzun
authors: University College London, United Kingdom.
authors: Christopher
authors: C
authors: Kibbler
authors: Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Switzerland.
authors: Oscar
authors: O
authors: Marchetti
authors: European Organisation for Research and Treatment of Cancer (EORTC).
authors: Peter
authors: P
authors: de Burghgraeve
authors: European Organisation for Research and Treatment of Cancer (EORTC).
authors: Safaa
authors: S
authors: Ramadan
authors: European Organisation for Research and Treatment of Cancer (EORTC).
authors: Liisa
authors: L
authors: Pylkkanen
authors: Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
authors: Lieveke
authors: L
authors: Ameye
authors: Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
authors: Marianne
authors: M
authors: Paesmans
authors: J Peter
authors: JP
authors: Donnelly
authors: University Medical Centre St Radboud, Nijmegen, The Netherlands.
authors: Peter J
authors: PJ
authors: Donnelly
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents; D002175:Candida; D005260:Female; D016469:Fungemia / Q000150:complications* / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: cancer; candida; candidemia; leukemia