Background

Candida kruseiis 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 withC kruseifungemia in comparison withCandida albicansfungemia in patients with cancer.

Methods

Retrospective study of 57 cases ofC kruseifungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. TheC kruseicases were compared with 57 cases ofC albicansfungemia 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 kruseiaccounted for 5% of fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients withC kruseifungemia more often had leukemia than patients withC albicans(77% vs 11%;P= .02), whereas catheter-related infections were more common among patients withC albicansfungemia (42% vs 0%;P<.001). Patients withC kruseifungemia 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 withC kruseivs 28% inC 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 kruseifungemia 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.

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Abstract

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