Breakthrough candidemia with hematological disease: Results from a single-center retrospective study in Japan, 2009-2020.

Abstract

Breakthrough candidemia (BrC) is a significant problem in immunocompromised patients, particularly those with hematological disorders. To assess the characteristics of BrC in patients with hematologic disease treated with novel antifungal agents, we collected clinical and microbiological information on said patients from 2009 to 2020 in our institution. Forty cases were identified, of which 29 (72.5%) received hematopoietic stem cell transplant (HSCT)-related therapy. At BrC onset, the most administered class of antifungal agents were echinocandins, administered to 70% of patients. Candida guilliermondii complex was the most frequently isolated species (32.5%), followed by C. parapsilosis (30%). These two isolates were echinocandin-susceptible in vitro but had naturally occurring FKS gene polymorphisms that reduced echinocandin susceptibility. Frequent isolation of these echinocandin-reduced-susceptible strains in BrC may be associated with the widespread use of echinocandins. In this study, the 30-day crude mortality rate in the group receiving HSCT-related therapy was significantly higher than in the group not receiving it (55.2% versus 18.2%, P = .0297). Most patients affected by C. guilliermondii complex BrC (92.3%) received HSCT-related therapy and had a 30-day mortality rate of 53.8%; despite treatment administration, 3 of 13 patients had persistent candidemia. Based on our results, C. guilliermondii complex BrC is a potentially fatal condition in patients receiving HSCT-related therapy with echinocandin administration.

• Authors: Ruriko Nishida, Yoshihiro Eriguchi, Noriko Miyake, Yoji Nagasaki, Akiko Yonekawa, Yasuo Mori, Koji Kato, Koichi Akashi, Nobuyuki Shimono
• Journal: Medical mycology (Med Mycol) Vol. 61 Issue 6 (Jun 05 2023) ISSN: 1460-2709 [Electronic] England
• PMID: 37312399 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.

Chemical References

• Antifungal Agents
• Echinocandins

Topics

• Animals
• Candidemia (drug therapy, epidemiology, microbiology, veterinary)
• Antifungal Agents (therapeutic use)
• Retrospective Studies
• Candida
• Japan (epidemiology)
• Echinocandins (therapeutic use)
• Hematologic Diseases (complications, veterinary)
• Microbial Sensitivity Tests (veterinary)