Factors influencing recovery in patients with hemoblastoses and candidemia

Abstract

Aim. To study the factors influencing the results of treatment for candidemia (CE) in patients with blood system tumors. Subjects and methods. The investigation enrolled patients with hemoblastoses and CE. 30-day all-cause mortality was analyzed. Results. In an 8-year period (2006—2013), CE was diagnosed in 55 patients (median age, 50 years); there was a preponderance of patients with lymphomas (47%) and acute leukemias (27%). The causative agents of CE were C. albicans (38%), С. parapsilosis (17%), С. krusei (11%), C. guilliermondii (11%), C. lusitaniae (6%), C. tropicalis (6%), С. glabrata (3%), С. famata (3%), C. pelliculosa (3%), and C. kefyr (2%). 30-day all-cause mortality was 43.6%. Recovery was statistically significantly more frequently seen following removal of a central venous catheter (67% versus 13%; p=0.004; odds ratio (OR), 14); after use of an antifungal drug on day 1 of isolation of Candida spp. from blood cultures (62% versus 13%; p=0.01; OR, 12); and that of echocandin as a first-line agent (86% versus 42%; p=0.005; OR, 8.4). The poor predictors were septic shock (5% recovery rate versus 86% in the patients without this factor; p<0.0001; OR, 0.01), granulocytopenia (42% versus 88%; p=0.001; OR, 0.1); use of amphotericin B as a first-line drug (26% versus 71%; p=0.002; OR, 0.15); hemoblastosis recurrence or resistance (39% versus 73%; p=0.01; OR, 0.24). Multivariate analysis showed the positive impact of antifungal administration on day 1 of isolation of Candida spp. from blood cultures on treatment results (p=0.03; OR, 27). Conclusion. High mortality rates were noted in the patients with hemoblastoses and CE. The recovery rates were statistically significantly higher after use of echinocandin as a first-line agent, after that of an antifungal agent on day 1 of positive blood cultures, after removal of a central venous catheter, and hemoblastosis remission.

References

  1. Клясова Г.А., Сперанская Л.Л., Миронова А.В., Масчан М.А., Байдильдина Д.Д., Верещагина С.А., Капорская Т.С., Юрицина Н.Ю., Поспелова Т.И., Крайнова Л.Е., Маркина О.А., Трушина Е.Е., Бриллиантова А.Н., Фролова И.Н. Возбудители сепсиса у иммунокомпрометированных больных: структура и проблемы антибиотикорезистентности (результаты многоцентрового исследования). Гематология и трансфузиология. 2007;1:11-19.
  2. Gamaletsou MN, Walsh TJ, Zaotis Τ, Pagoni M, Kotsopoulou M, Voulgarelis M, Panayiotidis P, Vassilakopoulos T, Angelopoulou MK, 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 NV. A prospective, cohort, multicentre study of candidemia in hospitalized adult patients with haematological malignancies. Clin Microbiol Infect. 2014;20:1-7.
  3. Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, Harrison LN, Seaberg EC, Hajjeh RA, Teutsch SM. Excess mortality, hospital stay, and cost due to camdidemia surveillansce. Infect Control Hosp Epidemiol. 2005;26:540-547.
  4. Hachem R, Hanna H, Kontoyiannis D, Jiang Y, Raad I. The changing epidemiology of invasive candidiasis: Candida glabrata and Candida krusei as the leading causes of candidemia in hematologic malignancy. Cance. 2008;112(11):2493-2499.
  5. Drgona L, Kosmanova I, Rolencova M, Sedlacek P, Chrenkova V, Horakova J, Dzurenkova A, Zak P, Zavrelova A, Guman T, Tothova E, Mudry P, Foralova R, Novak J, Vokurka S, Kouba M, Ziakova B, Ligova A, Muzik J, Kandrnal V, Mayer J, Racil Z. Invasive candidemia/candidiasis on hematological wards in 2000—2012 — a results from FIND-Candida project. Trends in Medical Mycology (TIMM). 2013;56(3):55-167.
  6. Arendrup MC, Bruun B, Christensen JJ, Fuursted K, Johansen HK, Kjaeldgaard P, Knudsen JD, Kristensen L, Moller J, Nielsen L, Rosenvinge FS, Roder B, Schonheyder HC, Thomsen MK, Truberg K. National surveillance of fungemia in Denmark (2004 to 2009). J Clin Microbiol. 2011;49:325-334.
  7. Slavin MA, Sorrel TC, Marriott D, Thursky KA, Nguyen Q, Ellis DH, Morrissey CO, Chen SC. Candidemia in adult cancer patients: risks for fluconazole-resistant isolates and death. J AntimicrobChemoter. 2010;65(5):1042-1051.
  8. Клясова Г.А., Блохина Е.В., Грачева А.Н., Кравченко С.К., Паровичникова Е.Н., Галстян Г.М. Результаты лечения кандидемии у больных опухолями системы крови. Терапевтическийархив. 2013;11:41-46.
  9. Калинина И.И., Байдильдина Д.Д., Сунцова Е.В., Горонкова О.В., Хачатрян Л.А., Петрова У.Н., Солопова Г.Г., Синицына В.В., Новичкова Г.А., Масчан М.А., Литвинов Д.В., Мякова Н.В., Клясова Г.А., Масчан А.А. Результаты терапии кандидемии у детей с различными гематологическими и онкологическими заболеваниями в условиях одного центра. Онкогематология. 2011;3:24-34.
  10. Sipsas NV, Lewis RE, Tarrand J, Hachem R, Rolston KV, Raad II, Kontoyiannis DP. Candidemia in patients with hematologic malignanses in the era of new antifungal agents (2001—2007): stable incidence but changing epidemiology of a still frequently lethal infection. Canсer. 2009;115(20):4745-4752.
  11. De Pauw B, Walsh TJ, Donnelly P, Stevens DA, Edwards JE, Calandra T, Pappas P, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE. Revised definitions of invasive fungal disease from European organization for research and treatment of invasive fungal disease from European organization for research and treatment of cancer/invasive fungal infections cooperative group and the national institute of allergy and infectious diseases mycoses study group EORTC/MSG) consensus group. Clin Infect Dis. 2008; 46(12):1813-1821.
  12. Segal BH, Herbrecht R, Stevens DA, Ostrosky-Zeichner L, Sobe J, Viscoli C, Walsh TJ, Maertens J, Patterson TF, Perfect JR, Dupont B, Wingard JR, Calandra T, Kauffman C, Graybill JR, Baden LR, Pappas PG, Bennett JE, Kontoyiannis DP, Cordonnier C, Viviani MA, Bille J, Almyroudis NG, Wheat LJ, Graninger W, Bow E, Holland S, Kullberg B, Dismukes W, De Pauw B. Defining Responses to Therapy and Study Outcomes in Clinical Trials of Invasive Fungal Diseases: Mycoses Study Group and European Organization for Research and Treatment of Cancer Consensus Criteria. Clin Infect Dis. 2008;47(5):674-683.
  13. Mora-Duarte J, Betts R, Rotstein C, Colombo AL, Thompson-Moya L, Smietana J, Lupinacci R, Sable C, Kartsonis N, Perfect J. Comparison of caspofungin and amphotericin B for invasive candidiasis. New Engl J Med. 2002;347(25):2020-2029.
  14. Reboli AC, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, Betts R, Wible M, Goldstein BP, Schranz J, Krause DS, Walsh TJ. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356(24):2472-2482.
  15. Kuse ER, Chetchotisakd P, da Cunha CA, Ruhnke M, Barrios C, Raghunadharao D, Sekhon JS, Freire A, Ramasubramanian V, Demeyer I, Nucci M, Leelarasamee A, Jacobs F, Decruyenaere J, Pittet D, Ullmann AJ, Ostrosky-Zeichner L, Lortholary O, Koblinger S, Diekmann-Berndt H. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidiasis: a phase III randomised double-blind trial. Lancet. 2007;369(9572):1519-1527.
  16. Pappas PG, Rotstein CM, Betts RF, Nucci M, Talwar D, De Waele JJ, Vazquez JA, Dupont BF, Horn DL, Ostrosky-Zeichner L, Reboli AC, Suh B, Digumarti R, Wu C, Kovanda LL, Arnold LJ, Buell DN. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45(7):883-893.
  17. Andes DR, Safdar N, Baddley JW, Playford G, Reboli AC, Rex JH, Sobel JD, Pappas PG, Kullberg BJ. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012;54(8):1110-1122.
  18. Pagano L, Fianchi L, Fanci R, Candoni A, Caira M, Posteraro B, Morselli M, Valentini CG, Farina G, Mitra ME, Offidani M, Sanguinetti M, Tosti ME, Nosari A, Leone G, Viale P. Caspofungin for the treatment of candidemia in patients with haemotological malignansies. Clin Microbiol Infect. 2010;16(3):298-301.
  19. Betts R, Glasmacher A, Maertens J, Maschmeyer G, Vazquez JA, Teppler H, Taylor A, Lupinacci R, Sable C, Kartsonis N. Efficacy of caspofungin against invasive Candida or invasive Aspergillus infections in neutropenic patients. Cancer. 2006;106(2):466-473.
  20. Jarque I, Tormo M, Bello JL, Rovira M, Batlle M, Julià A, Tabares S, Rivas C, Fernández-Sevilla A, García-Boyero R, Debén G, González-Campos J, Capote FJ, Sanz MA. Caspofungin for the treatment of invasive fungal disease in hematological patients (ProCAS Study). Med Mycol. 2013;51(2):150-154.
  21. Sipsas NV, Lewis RE, Raad II, Kontoyiannis DP. Monotherapy with caspofungin for candidemia in adult patients with cancer: a retrospective, single institution study. Int Antimicrob Agents. 2009;34(1):95-98.
  22. Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503-535.
  23. Ullmann A, Akova M, Herbrecht R, Viscoli C, Arendrup MC, Arikan-Akdagli S, Bassetti M, Bille J, Calandra T, Castagnola E, Cornely OA, Donnelly JP, Garbino J, Groll AH, Hope WW, Jensen HE, Kullberg BJ, Lass-Flörl C, Lortholary O, Meersseman W, Petrikkos G, Richardson MD, Roilides E, Verweij PE, Cuenca-Estrella M. ESCMID guidelines for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation. Clin MicrobiolInfect. 2012;18(7):53-67.
  24. Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, Bearden DT. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. ClinInfect Dis. 2006;43(1):25-31.
  25. Hsu D, Nguyen M, Nguyen A, Law A, Wong-Beringer A. A multicenter study to evaluate the impact of timing of caspofungin administration on outcomes of invasive candidiasis in non-immunocompromised patients. J Antimicrob Chemother. 2010;65(8):1765-1770.
  26. Liu CY, Huang LJ, Wang WS, Chen TL, Yen CC, Yang MH, Hsiao LT, Liu CY, Chen PM, Chiou TJ. Candidemia in cancer patients: impact of early removal of non-tunneled central venous catheters on outcome. J Infect. 2009;58(2):154-160.
  27. Pasqualotto AC, Severo LC. The importance of central venous catheter removal in patients with candidaemia: time to rethink our practice? Clin Microbiol Infect. 2008;14(1):2-4.
  28. Anaissie EJ, Rex JH, Uzun O, Vartivarian S. Predictors of adverse outcome in cancer patients with candidemia. Am J Med. 1998;104(3):238-245.
  29. Velasco E, Bigni R. A prospective cohort study evaluating the prognostic impact of clinical characteristics and comorbid conditions of hospitaized adult and pediatric cancer patients with candidemia. Eur J Clin Microbiol Infect Dis. 2008;27(11):1071-1078.
  30. Puig-Asensio M, Padilla B, Garnacho-Montero J, Zaragoza O, Aguado JM, Zaragoza R, Montejo M, Muñoz P, Ruiz-Camps I, Cuenca-Estrella M, Almirante B. Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain. Clin Microbiol Infect. 2014;20(4):245-254.

Copyright (c) 2015 Klyasova G.A., Blokhina E.V., Gracheva A.N., Kravchenko S.K., Parovichnikova E.N., Okhmat V.A., Korobova A.G., Galstyan G.M., Kulikov S.M.

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