Treatment of candidaemia in patients with haematologic malignancies

Ref ID: 17762

Author:

I. Kalinina*, M. Maschan, N. Myakova, D. Litvinov, G. Klyasova,
A. Maschan

Author address:

Moscow, RU)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Candidemia is a severe complication in children with hematological
malignancies leading to a high mortality rate up to 50%. Increasing
resistance to azoles of C. albicans and prevalence of C. non-albicans are
two most significant modern trends in candidemia.
Patients: Thirty-four patients (24 M/10 F) with median age 6 (0.36-
17) years with different malignancies and bone marrow failures
developed 43 episodes of candidemia (EC). Systemic antifungal
prophylaxis was applied in 35 (82%) before EC, mostly with azoles
used in 32 pts. Absolute neutrophil count (ANC) at onset of EC was
<0.5 · 109/L in 26 (60.5%). Clinical manifestations were fever (100%), pneumonia (30%), endocarditis (9.3%), multiorgan failure (7%), septic shock (SS) (4.7%), chronic disseminated candidiasis (4.7%), skin rash (4.7%) and meningitis (2.4%). Results: C. albicans was isolated in five pts (eight strains) and Candida non-albicans - in 29 pts (36 strains). Twenty (45.5%) strains were resistant to fluconazole: 4/8 (50%) C. albicans and 16/36 (44%) C. non-albicans. All pts received antifungal therapy (monotherapy 19 EC, combination therapy 24 EC). Central venous catheter (CVC) was removed in 25 (58%) EC. In 21 (49%) EC G-CSF was administered. Outcome: Thirty-seven EC were cured, 6 (14%) patients died. Overall 30 days survival was 0.7 ± 0.13; 5-years’ OS - 0.45 ± 0.09. Factors of unfavorable prognosis were: advanced malignancy - 5 death of 10 EC vs 1 death of 33 EC in remission or aplasia after 1-st remission induction (p = 0.000), neutropenia at onset of EC: 6 of 26 vs 0 of 17 EC of pts with ANC more and less 500/mm3 respectively (p = 0.04), hematopoietic recovery (0 of 35 EC vs 6 of 8 EC with or without recovery, (p = 0.000) and CVC removal (1 of 25 EC with CVC removed vs 5 of 18 with CVC remained (p = 0.03). Conclusion: Candidemia remains an unresolved issue in pediatric hematology/oncology with high attributable mortality. Most of cases occur in spite of systemic antifungal prophylaxis. Stage of underlying disease, CVC removal and ANC recovery are the main variables influencing survival.

Abstract Number: NULL

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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