Candidaemia in patients with haematological disorders and stem cell transplant

ABSTRACT

The incidence of non-albicans species of C and ida has recently increased, especially in patients with malignant haematological disorders receiving fluconazole prophylaxis. A retrospective study of patients who developed c and idaemia at Riyadh Armed Forces Hospital between January 1992 and December 2002 was carried out. Thirty one episodes of c and idaemia occurred in 27 patients with a variety of haematological disorders. Twenty-four episodes were caused by non-albicans species of C and ida and only 7 episodes were caused by C.albicans. The most frequent underlying haematological disorders were acute myeloid leukaemia [AML] followed by acute lymphoblastic leukaemia [ALL]. The main predisposing factors for the development of c and idaemia were broad spectrum antibiotics, central venous catheters, neutropenia, cytotoxic chemotherapy, coexisting bacterial infections, steroid therapy, relapsing or untreated primary disease and fluconazole prophylaxis. Eight episodes were complicated by chronic disseminated c and idiasis. Amphotericin-B and amBi-some were used in the treatment of C and ida infections. The treatment was successful in 86% of the episodes of C. albicans and 50% of the episodes due to non-albicans species of C and ida. The highest mortality rate was encountered with C.tropicalis infections. C and idaemia is an important cause of mortality and morbidity in patients with malignant haematological disorders and stem cell transplant. The predominance of non-albicans species of C and ida especially C.krusei and C.tropicalis is alarming. The early administration of appropriate antifungal therapy and the removal of infected intravascular catheters improve the outcome considerably