Candida krusei Fungemia

Abstract

<h3>Background</h3> <i>Candida krusei</i>is inherently resistant to fluconazole and is emerging as a frequent cause of fungemia in patients with hematologic malignant neoplasms. <h3>Objective</h3> To determine the risk and prognostic factors associated with<i>C krusei</i>fungemia in comparison with<i>Candida albicans</i>fungemia in patients with cancer. <h3>Methods</h3> Retrospective study of 57 cases of<i>C krusei</i>fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The<i>C krusei</i>cases were compared with 57 cases of<i>C albicans</i>fungemia 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. <h3>Results</h3> At our institution,<i>C krusei</i>accounted for 5% of fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients with<i>C krusei</i>fungemia more often had leukemia than patients with<i>C albicans</i>(77% vs 11%;<i>P</i>= .02), whereas catheter-related infections were more common among patients with<i>C albicans</i>fungemia (42% vs 0%;<i>P</i>&lt;.001). Patients with<i>C krusei</i>fungemia had a lower response rate (51% vs 69%;<i>P</i>= .05), largely because they more frequently were neutropenic and had disseminated infection. Mortality related to fungemia was 49% in the cases with<i>C krusei</i>vs 28% in<i>C albicans</i>. Multiple logistic regression analysis showed that persistent neutropenia (<i>P</i>= .02) and septic shock (<i>P</i>= .002) were predictors of poor prognosis. <h3>Conclusion</h3> In neutropenic patients,<i>C krusei</i>fungemia 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.