Evaluation of Candida Species and Risk Factors in Haematologic Cancer Patients With Candidemia

Objective: In this study, agents of candidemia and predictive factors in patients with haematological malignancy are evaluated. Methods: All positive blood culture results of inpatients in haematology unit between January 2006 and December 2013 were determined using laboratory information system. Blood cultures in which Candida species grew were evaluated. The data collected included demographic characteristics, underlying diseases, type of stem cell transplantation, absolute neutrophil counts, the causative Candida spp. and co-infecting fungi or bacteria, occurrence of chorioretinitis-endophthalmitis, occurrence of rash, antifungal therapies and risk factors like diabetes mellitus, dialysis, total parenteral nutrition, surgery, presence of central venous catheter and corticosteroid use. Results: In the 8-year period, among 1379 positive blood cultures, 67 (4.9%) were due to fungal species. The agents were 57 (85.1%) Candida spp., 3 (4.5%) Aspergillus spp., 3 ( 4.5%) Trichosporon spp., 2 (3%) Saccharomyces spp. and 2 ( 3%) Geotrichium spp. Among the Candida species, the most frequently isolated species were non-albicans Candida ( 86%) dominated by C. tropicalis (51%). Five (8.7%) patients had a concomitant bacterial or fungal bloodstream infection other than Candida spp. The concomitant organisms included C. tropicalis and Enterococcus faecium (n=2), C. kefyr and Stenotrophomonas maltophilia (n=1), C. kefyr and Klebsiella sp. (n=1), and C. kefyr and C. glabrata (n=1). Caspofungin (33 patients, 57.9%) was the most frequently administered antifungal agent in candidemia, followed by amphotericin B (15 patients, 26.3%) and fluconazole (8 patients, 14%). Neutropenia (< 500/mm(3)) was found to be associated with candidemias with non-albicans species. Conclusions: The proportion of bloodstream infections due to non-albicans Candida species was high (86%). This changing epidemiology must be taken into consideration for optimal empirical treatment.