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10-04-2012 | Surgery | Article

Fungemia results in high mortality among cancer patients


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MedWire News: The overall incidence of fungemia in patients with cancer is low, but mortality is high among those affected, show data from the EORTC Infectious Diseases Study Group.

Speaking to MedWire News at the European Congress of Clinical Microbiology and Infectious Diseases in London, UK, Oliver Cornely (Uniklinik Köln, Germany) said that while bacteremia is more common in cancer patients than fungemia, it is mostly treatable. On the other hand, "fungal infections are a major challenge in patients with hematological malignancy, they carry a mortality of 50%."

Cornely and team therefore studied 145,030 patients with solid organ or hematologic cancer treated at one of 13 European Organization for Research and Treatment of Cancer (EORTC) centers in eight European countries. Data were analyzed for incidence of fungemia, demographics, clinical characteristics, and outcome.

Fungemia occurred in 333 (2.3 per 1000) patients, of whom 56% had solid tumors and 47 had hematologic malignancies.

The incidence of fungemia ranged from 1.5 cases per 1000 patients with solid tumors to 14.6 cases per 1000 patients who received haematopoietic stem cell transplantation for hematologic malignancies.

Cornely said that fungemia can affect any cancer patient, but that those with hematologic malignancies are at the greatest risk. However, "there is no way of predicting fungemia in the individual patient, and there is no specific sign or symptom to differentiate fungemia from other infection."

Indeed, at the time of fungemia, 38% of patients were neutropenic, 93% were febrile, and 31% had documented deep-organ involvement, most commonly the liver/spleen (4.5%) and kidney/urinary tract (3.8%).

Central venous catheters (CVCs) - a known risk factor for fungemia - were used in 80% of patients, peripheral cannulas in 10%, and both in 4%. The remaining 6% did not have catheters. Cornely reported that CVCs were removed in 67% of cases at a median of 3 days after diagnosis of fungemia by blood culture.

Cornely commented that in the cases where the catheter was left in place despite guideline recommendations to remove it within 48 hours, it is likely that physicians felt the patient's life could not be saved due to underlying diseases. "Fungemia in these patients was just another complication in an already desperate clinical situation," he told MedWire News.

Of the catheters removed (n=152), 67% were cultured for fungi, and 45% of these were culture positive. The majority (97%) of organisms detected by catheter culture matched those detected by blood culture.

The most common pathogens were Candida spp., which were detected in 86.9% of patients. Other yeasts were present in 5.7%, moulds in 2.4%, Cryptococcus spp. in 1.3%, and Trichoderma spp. in 0.7%. Around 3% of patients had mixed infections.

At 4 weeks postdiagnosis, the survival rate was 64%, but this decreased to 45% by the end of 12 weeks, the usual time-frame for an antifungal treatment strategy.

Fungemia was reported as the sole cause of death within 12 weeks in 5% of patients, but was a contributing factor in 44%. Cornely noted that there was a significant negative correlation between catheter retention and survival.

"Currently antifungal prophylaxis is the only evidence based life-saving strategy in populations with high risk," he concluded.

By Laura Cowen

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