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Infections Post Transplant

Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxis on incidence and outcome

Bone Marrow Transplantation volume 28, pages 873–878 (2001)Cite this article

Abstract

Candidemia is a serious complication in patients following allogeneic blood, marrow, and organ transplantation. Fourteen patients developed nosocomial fungemia among 204 allogeneic marrow transplants performed during 1997–1999. Incidence of hematogenous candidiasis was 6.8 per 100 allogeneic BMT. All 14 had an indwelling central venous catheter (CVC) and fluconazole (100–200 mg daily) was given prophylactically. In 11 (78.5%) neutropenic patients, duration between agranulocytosis and diagnosis of fungemia was (median, ± s.d.) 10 ± 8 days. Candida glabrata (53.3%) was the most common yeast species, followed by C. krusei (33.3%), and C. parapsilosis (13.3%). Candida albicans was conspicuously absent. Ten patients (71.4%) had primary transplant-related complication (>2 days) including hemolytic uremic syndrome/thrombotic thrombocytopenic purpura (HUS/TTP) (n = 5), severe hemorrhagic cystitis (n = 3), and bacteremia (n = 2). Seven (50.0%) patients expired and in three (21.4%) deaths were attributed to fungemia. The impact of a primary transplant-related complication on short-term survival in this setting was not significant (P = 0.07) (HUS/TTP (P > 0.5); neutropenia (P > 0.5); GVHD (P = 0.35)). Removal of CVC did not alter outcome in our group (P ⩾0.5) although in patients with persistent fungemia (>72 h), and those with preceding bacteremia, mortality was significantly higher (P = 0.002). Conventional prognosticators of poor outcome did not adversely effect short-term survival in our transplant recipients with hematogenous candidiasis. The predominance of C. glabrata and C. krusei breakthrough infections was similar to what is seen with high-dose fluconazole (400 mg) prophylaxis, and no adverse effects of low-dose fluconazole in terms of increased incidence of non-susceptible Candida species was seen. Bone Marrow Transplantation (2001) 28, 873–878.

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Acknowledgements

The results of this study were presented in part at the Eleventh International Symposium on Infections in the Immunocompromised Host of The International Immunocompromised Host Society (ICHS), Halifax, Nova Scotia, June 2000.

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Columbia, SC, USA

    A Safdar

  2. Division of Transplantation, Department of Medicine, University of South Carolina School of Medicine, and Palmetto-Richland Memorial Hospital, Columbia, SC, USA

    F van Rhee, JP Henslee-Downey, S Singhal & J Mehta

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Safdar, A., van Rhee, F., Henslee-Downey, J. et al. Candida glabrata and Candida krusei fungemia after high-risk allogeneic marrow transplantation: no adverse effect of low-dose fluconazole prophylaxis on incidence and outcome. Bone Marrow Transplant 28, 873–878 (2001). https://doi.org/10.1038/sj.bmt.1703252

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