A prospective, cohort, multicentre study of candidaemia in hospitalized adult patients with haematological malignancies
Open accessAbstract
Invasive candidiasis is a life-threatening infection in patients with haematological malignancies. The objective of our study was to determine the incidence, microbiological characteristics and clinical outcome of candidaemia among hospitalized adult patients with haematological malignancies. This is a population-based, prospective, multicentre study of patients ≥ 18 years admitted to haematology and/or haematopoietic stem cell transplantation units of nine tertiary care Greek hospitals from January 2009 through to February 2012. Within this cohort, we conducted a nested case-control study to determine the risk factors for candidaemia. Stepwise logistic regression was used to identify independent predictors of 28-day mortality. Candidaemia was detected in 40 of 27,864 patients with haematological malignancies vs. 967 of 1,158,018 non-haematology patients for an incidence of 1.4 cases/1000 admissions vs. 0.83/1000 respectively (p <0.001). Candidaemia was caused predominantly (35/40, 87.5%) by non-Candida albicans species, particularly Candida parapsilosis (20/40, 50%). In vitro resistance to at least one antifungal agent was observed in 27% of Candida isolates. Twenty-one patients (53%) developed breakthrough candidaemia while receiving antifungal agents. Central venous catheters, hypogammaglobulinaemia and a high APACHE II score were independent risk factors for the development of candidaemia. Crude mortality at day 28 was greater in those with candidaemia than in control cases (18/40 (45%) vs. 9/80 (11%); p <0.0001). In conclusion, despite antifungal prophylaxis, candidaemia is a relatively frequent infection associated with high mortality caused by non-C. albicans spp., especially C. parapsilosis. Central venous catheters and hypogammaglobulinaemia are independent risk factors for candidaemia that provide potential targets for improving the outcome.
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Gamaletsou et al. reported that Candida parapsilosis accounted for 50% of hospitalized adult patients with hematologic malignancies.
“In a prospective cohort multicenter study, Gamaletsou, et al. reported that C. parapsilosis accounted for 50% of hospitalized adult patients with hematologic malignancies.29”
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- Authors
- Gamaletsou, M. N., Walsh, T. J., Zaoutis, T., Pagoni, M., Kotsopoulou, M., Voulgarelis, M., Panayiotidis, P., Vassilakopoulos, T., Angelopoulou, M. K., Marangos, M., Spyridonidis, A., Kofteridis, D., Pouli, A., Sotiropoulos, D., Matsouka, P., Argyropoulou, A., Perloretzou, S., Leckerman, K., Manaka, A., Oikonomopoulos, P., Daikos, G., Petrikkos, G., & Sipsas, N. V.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- Cornell University (US)
- Children's Hospital of Philadelphia (US)
- Evangelismos Hospital (GR)
- Metaxa Hospital (GR)
- University of Patras (GR)
- University of Crete (GR)
- St Savas Hospital (GR)
- G. Papanikolaou General Hospital (GR)
- University of Thessaly (GR)
- Corresponding author
- Sipsas, N.V.
- ORCID
- Venue
- Clinical Microbiology and Infection
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 20
- Issue
- 1
- Pages
- O50-O57
- ISSN
- 1198-743X (ISSN-L)
- OpenAlex
- W1909349784
- Cited by
- 112
- References
- 35
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 8 · 2023: 8 · 2022: 7 · 2021: 6 · 2020: 11 · 2019: 9 · 2018: 10 · 2017: 10 · 2016: 8 · 2015: 12 · 2014: 4 · 2012: 1
- FWCI
- 5.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Microbiology and Infection (publishedVersion)
- PubMed (publishedVersion)
- University of Thessaly Institutional Repository (University of Thessaly) (submittedVersion)
- Funders
- Gilead Sciences
- Astellas Pharma
- 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, invasive candidiasis, hematologic malignancies, non-albicans Candida, Candida parapsilosis, antifungal resistance, antifungal prophylaxis, central venous catheters, hypogammaglobulinemia, APACHE II score, 28-day mortality, risk factors, incidence
- MeSH terms
- Adolescent, Adult, Agammaglobulinemia, Aged, Aged, 80 and over, Antifungal Agents, Candida, Female, Greece, Hospitalization, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Logistic Models, Case-Control Studies, Hematologic Neoplasms, Young Adult, Candidemia, Central Venous Catheters
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