Candida glabrata fungemia in a tertiary cancer institution in Slovakia.

Because of controversial data on virulence and mortality, six cases of fungemia caused by Candida glabrata were reviewed in a single cancer institution within 8 years. Risk factors and outcome of C. glabrata, Candida albicans, and other non-albicans Candida spp. appearing within the same period under the same antibiotic policy at the same institution were compared. Among other non-albicans Candida spp. in 1990-1997 C. glabrata fungemias showed a decreasing tendency, from 9% to 4.5% in 1997. Analyzing the proportion of C. glabrata among blood cultures, among 170 positive blood cultures 12 were caused by C. glabrata (6.2% among all pathogens and 24% among non-albicans Candida spp.). C. glabrata among all fungemias was diagnosed as the fourth most common pathogen after C. albicans, C. krusei, and C. parapsilosis. Three of six C. glabrata fungemias were breakthrough. Two appeared during prophylaxis with itraconazole and one during fluconazole prophylaxis. Five of six received broadspectrum antibiotic therapy with third-generation cephalosporines, five of six had vascular catheter insertion, four of six were neutropenic, and two of six received amphotericin B therapy. One patient died before his blood cultures were reported to be positive. Overall mortality of C. glabrata fungemia was 16.7%. One patient died of underlying disease with fungemia. There were no significant differences in risk factors between C. glabrata and C. albicans. However, overall and crude mortality was lower in C. glabrata than in C. albicans (25.5% vs. 16.7%; P = 0.03). Attributable mortality was lower in comparison to C. albicans (0 vs. 15.7% in C. albicans; P = 0.001).

Bacteremia due to multiresistant gram-negative bacilli in neutropenic cancer patients: a case-controlled study.

The aim of this study was to assess whether multiresistant gram-negative bacteremias (MRGNB) were associated with specific risk factors for higher mortality than sensitive gram-negative bacteremias. Two groups of subjects: (51 cases and 102 controls) were matched for sex, age, underlying disease, and neutropenia. There were no significant differences in the incidence of cytotoxic chemotherapy administered, vascular catheter insertion, catheter as source of bacteremia, and etiology of bacteremia. The proportion of Klebsiella-Enterobacter, Pseudomonas aeruginosa, Acinetobacter spp., and Stenotrophomonas maltophilia was similar in the two groups. Prior surgery (21.6% vs 7.9%, P < 0.05) was significantly associated with sensitive gram-negative bacteremia. Previous prophylaxis with ofloxacin (45.1% vs 24.5%; P < 0.05) and prior therapy with broad-spectrum antibiotics (41.2% vs 27.5%; P < 0.05), such as first and second generation cephalosporins (19.6% vs 7.8%; P < 0.05), third generation cephalosporins (41.2% vs 13.7%; P < 0.01), aminoglycosides (39.2% vs 9.8%; P < 0.01), ofloxacin (11.8% vs 2.0%; P < 0.005), and imipenem (19.6% vs 2.0%; P < 0.001) were significantly more frequently observed among cases than controls. Cases (patients with bacteremia due to multiresistant gram-negative bacteremias) were also significantly more frequently infected with bacteria resistant to ceftazidime (68.6% vs 17.6%; P < 0.001), amikacin (52.9% vs 7.8%; P < 0.001), imipenem (50.1% vs 23.5%; P < 0.05), ciprofloxacin (32.1% vs 5.9%; P < 0.001), and piperacillin (41.2% vs 7.8%; P < 0.01). With regard to outcome, attributable mortality was similar (15.7% vs 13.8%; not significant) in the two groups; however, cure rates were lower among cases (patients infected with MRGNB) because crude mortality was higher in cases (35.3% vs 13.8%; P < 0.01) than in controls.

Incidence, Clinical Features, Risk Factors and Outcome of Bacteremia due to Vancomycin-Resistant and Vancomycin-Sensitive Enterococcus Species Analyzed Over a 7-year Period in a Single Cancer Institution.

The aim of this study was to retrospectively compare the incidence, risk factors, and outcome in patients seen over a 7-year period at the National Cancer Institute in the Slovak Republic, with vancomycin-sensitive or vancomycin-resistant enterococcal bacteremia. The total incidence of enterococcal bacteremia at the National Cancer Institute increased from 5.1% in 1991 to 11.1% in 1993 and then decreased to 4.3% in 1995. Analysis of the 77 episodes of enterococcal bacteremia from 66 patients showed that 69 episodes from 60 patients were due to vancomycin-sensitive Enterococcus faecalis (group 1) and 8 episodes from 8 patients were due to vancomycin-resistant Enterococcus faecium (group 2). The features most frequently associated with enterococcal bacteremia were the insertion of a central venous catheter, neutropenia lasting more than 10 days, previous therapy with cephalosporins or vancomycin, previous prophylaxis with quinolones, and the incidence of superinfections. There was no difference in the clinical course or outcome between the 2 study groups. Previous therapy with aminoglycosides, cephalosporins, vancomycin or imipenem, neutropenia less than 10 days in length, malignancies other than leukemia or solid tumors, and the incidence of breakthrough bacteremia significantly correlated with patients with vancomycin-resistant E. faecium rather than patients with vancomycin-sensitive E. faecalis. The overall mortality was similar in both groups and averaged 32.5% for all enterococcal bacteremic patients. In this study, the major risk factors associated with cancer patients for developing vancomycin-resistant enterococcal bacteremia were previous therapy with aminoglycosides, cephalosporins or vancomycin, superinfections with other organisms and the incidence of breakthrough bacteremia.