Predictors of Adverse Outcome in Cancer Patients with Candidemia
Abstract
Background Many factors, including severity of illness, neutropenia, intravenous catheter management, and drug therapy may affect the outcome of candidemia in cancer patients.Methods The records of all patients at M. D. Anderson Cancer Center who developed one or more positive blood cultures for Candida spp between January 1, 1988, and December 31, 1992, were retrospectively reviewed. Four hundred ninety-one episodes of candidemia were identified, for which 476 had complete medical records, which were reviewed in detail.Results By 3-month follow-up, 52% of the patients had died. Neutropenia, higher APACHE III score, and visceral dissemination were associated with poor prognosis. Cure rates, adjusted for severity of illness, were similar for fluconazole and amphotericin B treatment. Exchange of central venous catheters was associated with a modest improvement in prognosis.Conclusion Several factors that influence the outcome of candidemia in cancer patients have been identified. These factors may be relevant for the clinical management of cancer patients with candidemia, and for the design of therapeutic trials.
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Two large randomized studies and 2 large observational studies have demonstrated that fluconazole (400 mg/day) and amphotericin B deoxycholate (0.5-0.6 mg/kg per day) are similarly effective as therapy.
“Two large randomized studies [105, 106] and 2 large observational studies [107, 108] have demonstrated that fluconazole (400 mg/day) and amphotericin B deoxycholate (0.5-0.6 mg/kg per day) are similarly effective as therapy.”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [107]
Fungemia due to C. parapsilosis is very frequently associated with use of catheters.
“An exception is made for fungemia due to C. parapsilosis, which is very frequently associated with use of catheters (A-II) [107].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [107]
In neutropenic patients, the gut is a source for disseminated candidiasis, evident from autopsy studies.
“In neutropenic patients, the role of the gut as a source for disseminated candidiasis is evident from autopsy studies”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [107]
In an individual patient, it is difficult to determine the relative contributions of the gut and a catheter as primary sources of fungemia.
“in an individual patient, it is difficult to determine the relative contributions of the gut and a catheter as primary sources of fungemia [107,108,118].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [107]
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- Authors
- Anaissie, E. J., Rex, J. H., Uzun, Ö., & Vartivarian, S.
- Affiliations
- The University of Texas MD Anderson Cancer Center (US)
- The University of Texas Health Science Center at Houston (US)
- Corresponding author
- Anaissie, Elias J
- ORCID
- Rex, John H
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1998-03
- Volume
- 104
- Issue
- 3
- Pages
- 238-245
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2083121860
- Cited by
- 295
- References
- 36
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 1 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 1 · 2015: 9 · 2014: 6 · 2013: 9 · 2012: 11
- FWCI
- 11.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer Pharmaceuticals
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Keywords
- candidemia, candidiasis, cancer patients, prognosis, neutropenia, APACHE III score, visceral dissemination, fluconazole, amphotericin B, mortality, bloodstream infection
- MeSH terms
- Adult, Aged, Analysis of Variance, Antifungal Agents, Candidiasis, Female, Humans, Male, Middle Aged, Neoplasms, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk, Risk Factors, Time Factors, Odds Ratio, Fungemia, Treatment Outcome
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