National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, China.
Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.
Clin Infect Dis. 2020 Dec 23;71(Suppl 4):S394-S399. doi: 10.1093/cid/ciaa1523.
Antifungal prophylaxis may result in breakthrough infections in hematology patients with severe agranulocytosis, with few studies assessing risk factors and clinical outcomes of breakthrough candidemia. We described the distribution of Candida species, assessed risk factors for mortality in such patients, and determined differences in the incidence and mortality of breakthrough candidemia between patients who did or did not receive an allogeneic hematopoietic stem cell transplant.
We collected clinical and microbiological data of patients with hematologic malignancies and breakthrough candidemia from a single center. Seven-day and 30-day follow-up outcomes were recorded; the incidence and mortality of breakthrough candidemia between patients who did or did not undergo an allogeneic transplant were compared. Kaplan-Meier survival estimates were used to generate survival curves, and predictors were identified using Cox regression analyses.
Of 71 enrolled patients, 17 received allogeneic transplants. Incidences of breakthrough candidemia were 17 of 2924 (0.58%) and 54 of 12 015 (0.45%) in the transplant and nontransplant groups, respectively (P = .35). The most common isolate was Candida tropicalis, and antifungal agent combinations were the most common first-line treatment. Cumulative mortality rates of patients were 21.1% and 31.0% at days 7 and 30, respectively, and they significantly differed between both groups. Septic shock, central venous catheter removal, and granulocyte recovery were significantly associated with 7-day mortality; the latter 2 remained independent predictors of 30-day mortality.
Breakthrough candidemia-related mortality was higher in the allogeneic transplant group, although the incidence was not significantly different between the groups. Prompt and adequate antifungal treatment with catheter removal may reduce mortality.
在患有严重粒细胞减少症的血液病患者中，抗真菌预防可能导致突破性感染，很少有研究评估此类患者发生突破性念珠菌血症的危险因素和临床结局。我们描述了念珠菌属的分布，评估了此类患者死亡的危险因素，并确定了接受或未接受异基因造血干细胞移植的患者中突破性念珠菌血症的发生率和死亡率之间的差异。
我们从一家单中心收集了血液恶性肿瘤和突破性念珠菌血症患者的临床和微生物学数据。记录了 7 天和 30 天的随访结果；比较了接受或未接受异基因移植的患者中突破性念珠菌血症的发生率和死亡率。使用 Kaplan-Meier 生存估计生成生存曲线，并使用 Cox 回归分析确定预测因素。
在 71 名入组患者中，有 17 名接受了异基因移植。在移植组和非移植组中，突破性念珠菌血症的发生率分别为 2924 例中的 17 例（0.58%）和 12015 例中的 54 例（0.45%）（P=.35）。最常见的分离株是热带念珠菌，抗真菌药物联合治疗是最常见的一线治疗。第 7 天和第 30 天的患者累积死亡率分别为 21.1%和 31.0%，两组之间差异显著。败血症性休克、中心静脉导管拔除和粒细胞恢复与第 7 天的死亡率显著相关；后两者是第 30 天死亡率的独立预测因素。
尽管两组之间的发生率无显著差异，但异基因移植组中与突破性念珠菌血症相关的死亡率较高。及时、充分的抗真菌治疗并去除导管可能会降低死亡率。
