Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: No adverse effect of low-dose fluconazole prophylaxis on incidence and outcome

A. Safdar*, F. Van Rhee, J. P. Henslee-Downey, S. Singhal, J. Mehta

*Corresponding author for this work

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Candidemia is a serious complication in patients following allogeneic blood, marrow, and organ transplantation. Fourteen patients developed nosocomial fungemia among 204 allogeneic marrow transplants performed during 1997-1999. Incidence of hematogenous candidiasis was 6.8 per 100 allogeneic BMT. All 14 had an indwelling central venous catheter (CVC) and fluconazole (100-200 mg daily) was given prophylactically. In 11 (78.5%) neutropenic patients, duration between agranulocytosis and diagnosis of fungemia was (median, ± s.d.) 10 ± 8 days. Candida glabrata (53.3%) was the most common yeast species, followed by C. krusei (33.3%), and C. parapsilosis (13.3%). Candida albicans was conspicuously absent. Ten patients (71.4%) had primary transplant-related complication (>2 days) including hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) (n = 5), severe hemorrhagic cystitis (n = 3), and bacteremia (n = 2). Seven (50.0%) patients expired and in three (21.4%) deaths were attributed to fungemia. The impact of a primary transplant-related complication on short-term survival in this setting was not significant (P = 0.07) (HUS/TTP (P > 0.5); neutropenia (P > 0.5); GVHD (P = 0.35)). Removal of CVC did not alter outcome in our group (P ≥0.5) although in patients with persistent fungemia (>72 h), and those with preceding bacteremia, mortality was significantly higher (P = 0.002). Conventional prognosticators of poor outcome did not adversely effect short-term survival in our transplant recipients with hematogenous candidiasis. The predominance of C. glabrata and C. krusei breakthrough infections was similar to what is seen with high-dose fluconazole (400 mg) prophylaxis, and no adverse effects of low-dose fluconazole in terms of increased incidence of non-susceptible Candida species was seen.

Original languageEnglish (US)
Pages (from-to)873-878
Number of pages6
JournalBone Marrow Transplantation
Volume28
Issue number9
DOIs
StatePublished - Dec 13 2001

Keywords

  • BMT
  • C. glabrata
  • C. krusei
  • Fluconazole prophylaxis
  • Fungemia

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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