Failure of Systemic Empirical Treatment with Amphotericin B to Prevent Candidemia in Neutropenic Patients with Cancer
Abstract
We undertook a retrospective review of all patients with hematologic malignancies in whom candidemia developed during chemotherapy-induced neutropenia in 1989 and 1990. Candidemia developed in 11 patients; five were receiving therapeutic doses of amphotericin B at the time of infection. Disseminated infection occurred in 2 of 5 patients with breakthrough infection and 3 of 6 patients with candidemia before receipt of amphotericin B. Among patients with breakthrough candidemia there was a trend toward more-prolonged neutropenia prior to infection (P = .069), but otherwise they were indistinguishable from other candidemic patients with regard to risk factors for candidemia. Amphotericin B-susceptible Candida albicans was isolated from two patients and Candida krusei from three patients with breakthrough infection. All patients were treated with amphotericin B; all breakthrough infections responded to treatment. Neutropenic patients with breakthrough candidemia were clinically similar to those whose candidemia preceded amphotericin B therapy, and there was no increase in morbidity and mortality among individuals with breakthrough infection.
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Breakthrough or persistence of candidemia during antifungal therapy suggests an infected intravascular device, significant immunosuppression, or microbiological resistance.
“Breakthrough (or persistence of) candidemia in the face of ongoing antifungal therapy suggests the possibility of an infected intravascular device [135], significant immunosuppression [136], or microbiological resistance.”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [135]
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- Authors
- Blumberg, E. A., & Reboli, A. C.
- Corresponding author
- Blumberg, E. A.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-03-01
- Volume
- 22
- Issue
- 3
- Pages
- 462-466
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W1975408222
- Cited by
- 45
- References
- 18
- Citations by year
- 2021: 1 · 2019: 1 · 2017: 4 · 2014: 3 · 2012: 1
- FWCI
- 4.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- 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, amphotericin B, chemotherapy-induced neutropenia, hematologic malignancies, Candida krusei, Candida albicans, antifungal prophylaxis, systemic candidiasis, risk factors
- MeSH terms
- Acute Disease, Adult, Aged, Amphotericin B, Candida, Candida albicans, Candidiasis, Female, Humans, Leukemia, Myeloid, Male, Middle Aged, Neutropenia, Retrospective Studies, Treatment Failure, Fatal Outcome, Precursor Cell Lymphoblastic Leukemia-Lymphoma
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