Failure of systemic empirical treatment with amphotericin B to prevent candidemia in neutropenic patients with cancer

Clin Infect Dis. 1996 Mar;22(3):462-6. doi: 10.1093/clinids/22.3.462.

Abstract

We undertook a retrospective review of all patients with hematologic malignancies in whom candidemia developed during chemotherapy-induced neutropenia in 1989 and 1990. Candidemia developed in 11 patients; five were receiving therapeutic doses of amphotericin B at the time of infection. Disseminated infection occurred in 2 of 5 patients with breakthrough infection and 3 of 6 patients with candidemia before receipt of amphotericin B. Among patients with breakthrough candidemia there was a trend toward more-prolonged neutropenia prior to infection (P = .069), but otherwise they were indistinguishable from other candidemic patients with regard to risk factors for candidemia. Amphotericin B-susceptible Candida albicans was isolated from two patients and Candida krusei from three patients with breakthrough infection. All patients were treated with amphotericin B; all breakthrough infections responded to treatment. Neutropenic patients with breakthrough candidemia were clinically similar to those whose candidemia preceded amphotericin B therapy, and there was no increase in morbidity and mortality among individuals with breakthrough infection.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Amphotericin B / therapeutic use*
  • Candida / isolation & purification*
  • Candida albicans / drug effects
  • Candida albicans / isolation & purification*
  • Candidiasis / complications
  • Candidiasis / drug therapy*
  • Candidiasis / parasitology
  • Fatal Outcome
  • Female
  • Humans
  • Leukemia, Myeloid / complications*
  • Leukemia, Myeloid / parasitology
  • Male
  • Middle Aged
  • Neutropenia / complications*
  • Neutropenia / parasitology
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / parasitology
  • Retrospective Studies
  • Treatment Failure

Substances

  • Amphotericin B