 |
|
Candida krusei Fungemia
An Escalating Serious Infection in Immunocompromised Patients
Jalal Abbas, MD;
Gerald P. Bodey, MD;
Hend A. Hanna, MD, MPH;
Masoud Mardani, MD;
Essam Girgawy, MD;
Dima Abi-Said, PhD;
Estella Whimbey, MD;
Ray Hachem, MD;
Issam Raad, MD
Arch Intern Med. 2000;160:2659-2664.
Background Candida krusei is inherently resistant to fluconazole and is emerging as a frequent cause of fungemia in patients with hematologic malignant neoplasms.
Objective To determine the risk and prognostic factors associated with C krusei fungemia in comparison with Candida albicans fungemia in patients with cancer.
Methods Retrospective study of 57 cases of C krusei fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C krusei cases were compared with 57 cases of C albicans fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Evaluation II score, immunosuppression status, chemotherapy, and the use of central venous catheters, as well as fluconazole prophylaxis.
Results At our institution, C krusei accounted for 5% of fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients with C krusei fungemia more often had leukemia than patients with C albicans (77% vs 11%; P = .02), whereas catheter-related infections were more common among patients with C albicans fungemia (42% vs 0%; P<.001). Patients with C krusei fungemia had a lower response rate (51% vs 69%; P = .05), largely because they more frequently were neutropenic and had disseminated infection. Mortality related to fungemia was 49% in the cases with C krusei vs 28% in C albicans. Multiple logistic regression analysis showed that persistent neutropenia (P = .02) and septic shock (P = .002) were predictors of poor prognosis.
Conclusion In neutropenic patients, C krusei fungemia is associated with high mortality. It should be suspected in patients with leukemia who are receiving fluconazole prophylaxis and should be treated aggressively with an amphotericin B regimen.
From the Sections of Infection Control and Infectious Diseases, Department of Internal Medicine Specialties (Drs Abbas, Bodey, Hanna, Mardani, Girgawy, Whimbey, Hachem, Raad) and Department of Neurosurgery (Dr Abi-Said), The University of Texas M. D. Anderson Cancer Center, Houston.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Candida krusei, a Multidrug-Resistant Opportunistic Fungal Pathogen: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005
Pfaller et al.
J. Clin. Microbiol. 2008;46:515-521.
ABSTRACT
| FULL TEXT
Strain Typing and Determination of Population Structure of Candida krusei by Multilocus Sequence Typing
Jacobsen et al.
J. Clin. Microbiol. 2007;45:317-323.
ABSTRACT
| FULL TEXT
Antifungal Prophylaxis to Prevent Neonatal Candidiasis: A Survey of Perinatal Physician Practices
Burwell et al.
Pediatrics 2006;118:e1019-e1026.
ABSTRACT
| FULL TEXT
Candida krusei fungaemia: antifungal susceptibility and clinical presentation of an uncommon entity during 15 years in a single general hospital
Munoz et al.
J Antimicrob Chemother 2005;55:188-193.
ABSTRACT
| FULL TEXT
Comparison of PCR- and HinfI Restriction Endonuclease-Based Methods for Typing of Candida krusei Isolates
Sancak et al.
J. Clin. Microbiol. 2004;42:5889-5891.
ABSTRACT
| FULL TEXT
Pulmonary Infiltrates in the Non-HIV-Infected Immunocompromised Patient: Etiologies, Diagnostic Strategies, and Outcomes
Shorr et al.
Chest 2004;125:260-271.
ABSTRACT
| FULL TEXT
Evidence-based assessment of primary antifungal prophylaxis in patients with hematologic malignancies
Cornely et al.
Blood 2003;101:3365-3372.
ABSTRACT
| FULL TEXT
Genetic Basis for Differential Activities of Fluconazole and Voriconazole against Candida krusei
Fukuoka et al.
Antimicrob. Agents Chemother. 2003;47:1213-1219.
ABSTRACT
| FULL TEXT
Prospective, Multicenter Surveillance Study of Candida glabrata: Fluconazole and Itraconazole Susceptibility Profiles in Bloodstream, Invasive, and Colonizing Strains and Differences between Isolates from Three Urban Teaching Hospitals in New York City (Candida Susceptibility Trends Study, 1998 to 1999)
Safdar et al.
Antimicrob. Agents Chemother. 2002;46:3268-3272.
ABSTRACT
| FULL TEXT
Increasing Incidence of Candidemia: Results from a 20-Year Nationwide Study in Iceland
Asmundsdottir et al.
J. Clin. Microbiol. 2002;40:3489-3492.
ABSTRACT
| FULL TEXT
Fluconazole and Candida krusei Fungemia
Girmenia et al.
Arch Intern Med 2001;161:2267-2269.
FULL TEXT
A highly polymorphic degenerate microsatellite for molecular strain typing of Candida krusei
Shemer et al.
Microbiology 2001;147:2021-2028.
ABSTRACT
| FULL TEXT
|
