Epidemiology and outcomes of Candida spp. bloodstream infections in cancer patients: a comparative retrospective study from a German tertiary cancer center.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-04-02 DOI:10.1007/s15010-025-02513-z

Sebastian Wolf, Sarah Weber, Aaron Janetta, Friederike Klein, Julius C Enssle, Michael Hogardt, Volkhard A J Kempf, Johanna Kessel, Maria J G T Vehreschild, Björn Steffen, Thomas Oellerich, Hubert Serve, Sebastian Scheich

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引用次数: 0

Abstract

Background: Bloodstream infections (BSI) due to Candida spp. significantly contribute to morbidity and mortality among cancer patients. Understanding their clinical course, risk factors, and outcomes compared to bacterial BSI is essential.

Aim: We aim to elucidate the epidemiology and risk factors associated with Candida BSI compared to bacterial BSI in cancer patients.

Methods: We analyzed epidemiological data of Candida BSI versus bacterial BSI among cancer patients, primarily with hematological malignancies. Blood cultures were obtained upon clinical suspicion, with species identification by VITEK 2 and MALDI-TOF. Susceptibility testing utilized VITEK 2 or antibiotic gradient tests.

Results: Candida BSI was associated with higher 30-day mortality compared to bacterial BSI (Hazard ratio (HR) 4.5, 95% CI 2.5-8.1, p < 0.001) occurring predominantly in patients with relapsed/refractory disease. Univariate analysis identified risk factors for Candida BSI: hypoalbuminemia (Odds ratio (OR) 9.13, 95% CI 2.7-57, p = 0.003), prior ICU/MC stay (OR 3.91, 95% CI 1.38-9.65, p = 0.005), palliative treatment (OR 3.42, 95% CI 1.52-7.4, p = 0.002), parenteral nutrition (OR 2.44, 95% CI 0.9-5.5, p = 0.039) and prior allogeneic HSCT (OR 2.28, 95% CI 0.92-5.13, p = 0.056). Risk factors identified by multivariate analysis were palliative therapy (OR 5.23, 95% CI 3.14-8.71, p = 0.001), hypoalbuminemia (OR 9.02, 95% CI 4.23-19.2, p = 0.004), and prior ICU/IMC stay (OR 4, 95% CI 2.31-6.92, p = 0.011). In patients with confirmed Candida BSI, delayed initiation of antifungal was associated with worse outcomes.

Conclusion: Compared to bacterial BSI events, Candida BSI are associated with significantly higher 30-day mortality, primarily affecting heavily pretreated patients with relapsed or refractory disease.

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.