Candidaemia in haematological malignancy patients from a SEIFEM study: Epidemiological patterns according to antifungal prophylaxis

Brunella Posteraro, Giulia De Angelis, Maurizio Sanguinetti, Livio Pagano, Elena De Carolis, Marianna Criscuolo, Stefano Maria Picardi, Giulia Dragonetti, Stelvio Ballanti, Maria Ilaria Del Principe, Mario Delia, Nicola Fracchiolla, Francesco Marchesi, Gianpaolo Nadali, Marco Picardi, Anna Lina Piccioni, Luisa Verga, Anna Candoni, Alessandro Busca, Paola MuggeoMarta Stanzani, Chiara Cattaneo, Domenico Russo, Adriana Vacca, Rosa Fanci, Maria Rosaria De Paolis, Valentina Mancini, Federica Lessi, Elena Rossetti, Nunzia Decembrino, Luca Facchini, Antonella Ferrari, Stefano Vallero

Research output: Contribution to journalArticle

Abstract

Background: Candidaemia is an important infectious complication for haematological malignancy patients. Antifungal prophylaxis reduces the incidence of candidaemia but may be associated with breakthrough candidaemia. Objective: To analyse the Candida species’ distribution and relative antifungal susceptibility profiles of candidaemia episodes in relation to the use of antifungal prophylaxis among Italian SEIFEM haematology centres. Methodology: This multicentre retrospective observational SEIFEM study included 133 single-species candidaemia episodes of haematological malignancy patients for whom antifungal susceptibility testing results of blood Candida isolates were available between 2011 and 2015. Each participating centre provided both clinical and microbiological data. Results: Non-Candida albicans Candida (NCAC) species were the mostly isolated species (89, 66.9%), which accounted for C parapsilosis (35, 26.3%), C glabrata (16, 12.0%), C krusei (14, 10.5%), C tropicalis (13, 9.8%) and uncommon species (11, 8.3%). C albicans caused the remaining 44 (33.1%) episodes. Excluding 2 C albicans isolates, 23 of 25 fluconazole-resistant isolates were NCAC species (14 C krusei, 6 C glabrata, 2 C parapsilosis and 1 C tropicalis). Fifty-six (42.1%) of 133 patients developed breakthrough candidaemia. Systemic antifungal prophylaxis consisted of azoles, especially fluconazole and posaconazole, in 50 (89.3%) of 56 patients in whom a breakthrough candidaemia occurred. Interestingly, all these patients tended to develop a C krusei infection (10/56, P =.02) or a fluconazole-resistant isolate’s infection (14/50, P =.04) compared to patients (4/77 and 10/77, respectively) who did not have a breakthrough candidaemia. Conclusions: Optimisation of prophylactic strategies is necessary to limit the occurrence of breakthrough candidaemia and, importantly, the emergence of fluconazole-resistant NCAC isolates’ infections in haematological malignancy patients.
Original languageEnglish
Pages (from-to)900-910
Number of pages11
JournalMycoses
Volume63
DOIs
Publication statusPublished - 2020

Keywords

  • SEIFEM
  • antifungal prophylaxis
  • candidaemia
  • epidemiological study
  • haematological malignancy

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