The risk and clinical outcome of candidemia depending on underlying malignancy.
OBJECTIVE
To assess the risk factors and outcomes associated with fungemia caused by the six most commonly occurring Candida species in patients with and without malignancies.


METHODS
Analysis of the episodes of fungemia due to common Candida species in adults, based on an active hospital-based surveillance program (Paris area, France, 2002 to 2014).


RESULTS
Of the 3417 patients (3666 isolates), 1164 (34.1%) had a solid tumor (45.7% digestive tract) and 586 (17.1%) a hematological malignancy (41.8% lymphoma, 33.5% acute leukemia). The hematology patients were significantly younger, more often pre-exposed to antifungals, more often infected by C. tropicalis, C. krusei, or C. kefyr, and more often treated in the first instance with an echinocandin. Compared with inpatients who were not in ICU at the time of fungemia, those in ICU were less frequently infected by C. parapsilosis (p < 0.02), had more recent surgery (p < 0.03), and died more frequently before day 8 and day 30 (p < 0.0001). An increase in crude mortality over time in ICU was observed only in oncology patients (p < 0.04). For all patients, lack of prescription of antifungals despite knowledge of positive blood culture increased the risk of death. The odds of being infected by a given Candida species compared with C. albicans were uneven regarding age, gender, type of malignancy, hospitalization in ICU, central venous catheter, HIV status, intravenous drug addiction, and previous exposure to antifungal drugs. Compared with C. albicans, C. glabrata (OR = 0.69 [0.54-0.89]) and C. parapsilosis (OR = 0.49 [0.35-0.67]) were associated with a decreased risk of death by day 8 and day 30.


CONCLUSIONS
The clinical context of underlying malignancy and hospitalization in ICU may be relevant to the initial management of candidemia.
Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France. olivier.lortholary@pasteur.fr.|Université Paris Descartes, Hôpital Necker-Enfants malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, APHP, IHU Imagine, Paris, France. olivier.lortholary@pasteur.fr.
Olivier
O
Lortholary
Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France.
Charlotte
C
Renaudat
Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France.
Karine
K
Sitbon
Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France.
Marie
M
Desnos-Ollivier
Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France.|Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, AP-HP, Université Paris Diderot, Paris, France.
Stéphane
S
Bretagne
Institut Pasteur, Molecular Mycology Unit, French National Reference Center for Invasive Mycoses and Antifungals, CNRS URA3012, 25, rue du Dr. Roux, 75724, Paris Cedex 15, France.
Françoise
F
Dromer
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects*; D002175:Candida / Q000145:classification*; D058387:Candidemia / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D016638:Critical Illness / Q000401:mortality; D005260:Female; D015725:Fluconazole / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008223:Lymphoma; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011159:Population Surveillance; D012307:Risk Factors
D000935:Antifungal Agents; D015725:Fluconazole
Cancer; Candida; Echinocandins; Fluconazole; Hematological malignancy; ICU; Non-albicans species