title: [Factors influencing recovery in patients with hemoblastoses and candidemia].
abstract: aim: To study the factors influencing the results of treatment for candidemia (CE) in patients with blood system tumors.
  
  
  METHODS
  The investigation enrolled patients with hemoblastoses and CE. 30-day all-cause mortality was analyzed.
  
  
  RESULTS
  In an 8-year period (2006-2013), CE was diagnosed in 55 patients (median age, 50 years); there was a preponderance of patients with lymphomas (47%) and acute leukemias (27%). The causative agents of CE were C. albicans (38%), C. parapsilosis (17%), C. krusei (11%), C. guilliermondii (11%), C. lusitaniae (6%), C. tropicalis (6%), C. glabrata (3%), C. famata (3%), C. pelliculosa (3%), and C. kefyr (2%). 30-day all-cause mortality was 43.6%. Recovery was statistically significantly more frequently seen following removal of a central venous catheter (67% versus 13%; p=0.004; odds ratio (OR), 14); after use of an antifungal drug on day 1 of isolation of Candida spp. from blood cultures (62% versus 13%; p=0.01; OR, 12); and that of echocandin as a first-line agent (86% versus 42%; p=0.005; OR, 8.4). The poor predictors were septic shock (5% recovery rate versus 86% in the patients without this factor; p<0.0001; OR, 0.01), granulocytopenia (42% versus 88%; p=0.001; OR, 0.1); use of amphotericin B as a first-line drug (26% versus 71%; p=0.002; OR, 0.15); hemoblastosis recurrence or resistance (39% versus 73%; p=0.01; OR, 0.24). Multivariate analysis showed the positive impact of antifungal administration on day 1 of isolation of Candida spp. from blood cultures on treatment results (p=0.03; OR, 27).
  
  
  CONCLUSIONS
  High mortality rates were noted in the patients with hemoblastoses and CE. The recovery rates were statistically significantly higher after use of echinocandin as a first-line agent, after that of an antifungal agent on day 1 of positive blood cultures, after removal of a central venous catheter, and hemoblastosis remission.
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: G A
authors.initials: GA
authors.lastname: Klyasova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E V
authors.initials: EV
authors.lastname: Blokhina
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A N
authors.initials: AN
authors.lastname: Gracheva
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S K
authors.initials: SK
authors.lastname: Kravchenko
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: E N
authors.initials: EN
authors.lastname: Parovichnikova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: V A
authors.initials: VA
authors.lastname: Okhmat
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: A G
authors.initials: AG
authors.lastname: Korobova
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: G M
authors.initials: GM
authors.lastname: Galstyan
authors.affiliation: Hematology Research Center, Ministry of Health of Russia, Moscow, Russia.
authors.forename: S M
authors.initials: SM
authors.lastname: Kulikov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents