Candidemia in women with breast carcinoma treated with high-dose chemotherapy and autologous bone marrow transplantation.

Published

Journal Article

BACKGROUND: Invasive fungal infections, including candidemia, pose a major threat to patients with impaired immune defenses, including bone marrow transplantation (BMT) recipients. During 1992-1997, 845 women with multiple lymph node positive or metastatic breast carcinoma underwent high-dose chemotherapy (HDC) and subsequent autologous BMT at Duke University Medical Center. No systemic antifungal prophylaxis was administered. The purpose of the current study was to evaluate the risk and long-term outcome of candidemia in this patient population. METHODS: Clinical data were collected on patients with candidemia, and a group of age-matched control patients were identified who underwent HDC and BMT for breast carcinoma in the same time period. The difference in crude mortality between these two groups was used to calculate the attributable mortality of candidemia. The genetic relatedness of the fungal blood stream isolates was investigated by DNA fingerprinting. Antifungal susceptibility testing was performed using serial microdilution. RESULTS: Twenty-nine of 845 women developed candidemia (3.4%). The crude mortality of women with candidemia was 35% at 90 days after transplantation but 11% among women in the matched control group who were without infection (P = 0.01), for an attributable mortality rate of 24%. The most common pathogen was Candida tropicalis (50%), followed by Candida albicans (23%). The mortality was highest for women who were infected with C. albicans, followed by C. tropicalis, and other Candida species (P = 0.037). DNA fingerprinting of the yeasts revealed genetic heterogeneity in all species. However, 9 of 15 C. tropicalis isolates had identical DNA fingerprint profiles, suggesting spread of this genotype from a common source. All yeast isolates were susceptible to amphotericin B, and 20 of 30 isolates were susceptible to

Full Text

Duke Authors

Cited Authors

  • Gottfredsson, M; Vredenburgh, JJ; Xu, J; Schell, WA; Perfect, JR

Published Date

  • July 1, 2003

Published In

Volume / Issue

  • 98 / 1

Start / End Page

  • 24 - 30

PubMed ID

  • 12833451

Pubmed Central ID

  • 12833451

International Standard Serial Number (ISSN)

  • 0008-543X

Digital Object Identifier (DOI)

  • 10.1002/cncr.11470

Language

  • eng

Conference Location

  • United States