Oliver A Cornely1, Bertrand Gachot2, Hamdi Akan3, Matteo Bassetti4, Omrun Uzun5, Christopher Kibbler6, Oscar Marchetti7, Peter de Burghgraeve8, Safaa Ramadan8, Liisa Pylkkanen8, Lieveke Ameye9, Marianne Paesmans9, J Peter Donnelly, Peter J Donnelly10. 1. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne Department I of Internal Medicine, University Hospital Cologne Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, and German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany. 2. Institut Gustave Roussy Département de Soins Aigus, Institut Gustave-Roussy, Villejuif, France. 3. Ankara University School of Medicine, Turkey. 4. Santa Maria Misericordia Hospital, Udine, Italy. 5. Department of Medicine, Section of Infectious Diseases, Hacettepe University Medical School, Ankara, Turkey. 6. University College London, United Kingdom. 7. Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Switzerland. 8. European Organisation for Research and Treatment of Cancer (EORTC). 9. Institut Jules Bordet, Université Libre de Bruxelles, Belgium. 10. University Medical Centre St Radboud, Nijmegen, The Netherlands.
Abstract
BACKGROUND: Anti-cancer treatment and the cancer population have evolved since the last European Organisation for Research and Treatment of Cancer (EORTC) fungemia survey, and there are few recent large epidemiological studies. METHODS: This was a prospective cohort study including 145 030 admissions of patients with cancer from 13 EORTC centers. Incidence, clinical characteristics, and outcome of fungemia were analyzed. RESULTS: Fungemia occurred in 333 (0.23%; 95% confidence interval [CI], .21-.26) patients, ranging from 0.15% in patients with solid tumors to 1.55% in hematopoietic stem cell transplantation recipients. In 297 evaluable patients age ranged from 17 to 88 years (median 56 years), 144 (48%) patients were female, 165 (56%) had solid tumors, and 140 (47%) had hematological malignancies. Fungemia including polymicrobial infection was due to: Candida spp. in 267 (90%), C. albicans in 128 (48%), and other Candida spp. in 145 (54%) patients. Favorable overall response was achieved in 113 (46.5%) patients by week 2. After 4 weeks, the survival rate was 64% (95% CI, 59%-70%) and was not significantly different between Candida spp. Multivariable logistic regression identified baseline septic shock (odds ratio [OR] 3.04, 95% CI, 1.22-7.58) and tachypnoea as poor prognostic factors (OR 2.95, 95% CI, 1.66-5.24), while antifungal prophylaxis prior to fungemia (OR 0.20, 95% CI, .06-.62) and remission of underlying cancer (OR, 0.18; 95% CI, .06-.50) were protective. CONCLUSIONS: Fungemia, mostly due to Candida spp., was rare in cancer patients from EORTC centers but was associated with substantial mortality. Antifungal prophylaxis and remission of cancer predicted better survival.
BACKGROUND: Anti-cancer treatment and the cancer population have evolved since the last European Organisation for Research and Treatment of Cancer (EORTC) fungemia survey, and there are few recent large epidemiological studies. METHODS: This was a prospective cohort study including 145 030 admissions of patients with cancer from 13 EORTC centers. Incidence, clinical characteristics, and outcome of fungemia were analyzed. RESULTS: Fungemia occurred in 333 (0.23%; 95% confidence interval [CI], .21-.26) patients, ranging from 0.15% in patients with solid tumors to 1.55% in hematopoietic stem cell transplantation recipients. In 297 evaluable patients age ranged from 17 to 88 years (median 56 years), 144 (48%) patients were female, 165 (56%) had solid tumors, and 140 (47%) had hematological malignancies. Fungemia including polymicrobial infection was due to: Candida spp. in 267 (90%), C. albicans in 128 (48%), and other Candida spp. in 145 (54%) patients. Favorable overall response was achieved in 113 (46.5%) patients by week 2. After 4 weeks, the survival rate was 64% (95% CI, 59%-70%) and was not significantly different between Candida spp. Multivariable logistic regression identified baseline septic shock (odds ratio [OR] 3.04, 95% CI, 1.22-7.58) and tachypnoea as poor prognostic factors (OR 2.95, 95% CI, 1.66-5.24), while antifungal prophylaxis prior to fungemia (OR 0.20, 95% CI, .06-.62) and remission of underlying cancer (OR, 0.18; 95% CI, .06-.50) were protective. CONCLUSIONS: Fungemia, mostly due to Candida spp., was rare in cancer patients from EORTC centers but was associated with substantial mortality. Antifungal prophylaxis and remission of cancer predicted better survival.
Authors: G Goel; M Chandy; A Bhattacharyya; S Banerjee; S Chatterjee; S Mullick; S Sinha; K Sengupta; K Dhar; S Bhattacharya; S Rudramurthy; A Chakrabarti Journal: Eur J Clin Microbiol Infect Dis Date: 2017-08-11 Impact factor: 3.267
Authors: Tobias Lahmer; Jürgen Held; Sebastian Rasch; Christopher Schnappauf; Analena Beitz; Roland M Schmid; Wolfgang Huber Journal: Mycopathologia Date: 2016-09-12 Impact factor: 2.574
Authors: Tobias Lahmer; Sebastian Rasch; Christopher Schnappauf; Analena Beitz; Roland M Schmid; Wolfgang Huber Journal: Mycopathologia Date: 2016-05-03 Impact factor: 2.574