A retrospective study of 76 episodes of
candidemia in 73 patients with underlying
hematological malignancy, from 1988 until 1997, has been conducted to evaluate the clinical characteristics and to ascertain the variables related to the onset and the outcome of
candidemia. The most frequent
malignancy was
acute myeloid leukemia (29 episodes).
Candidemia developed mainly during aplasia in patients refractory to
chemotherapy (42%). In 65 episodes (86%) the patients were neutropenic (
ANC <1 x 10(9)/l) before the
candidemia diagnosis for a median time of 13 d, and in 53 episodes (70%) at microbiological diagnosis of
candidemia ANC was <1 x 10(9)/l. Candida albicans was the most frequently isolated etiologic agent (31 episodes), but C. non-albicans species sustained the majority of
candidemia. Seventeen candidemias developed during
azoles prophylaxis. One month after the diagnosis of
candidemia, 26 patients died. In 19 cases, death was attributable to
candidemia. The case-control study demonstrated, at univariate analysis, that the colonization with Candida. spp. (p=0.004), antimycotic prophylaxis (p=0.01), presence of
central venous catheter (p=0.01),
neutropenia (p=0.002), and the use of
glycopeptide (p=0.0001) increased the risk of
candidemia. Using multivariate regression analysis only colonization with Candida spp. and the previous
therapy with
glycopeptide were associated with a significantly increased risk. Acute mortality, expressed by a cumulative probability of survival at 30 d from diagnosis of
candidemia, was 0.67 (95% C.I. 0.55-0.77) and was significantly reduced in patients with neutrophils <1 x 10(9)/l when compared to those with neutrophils >1 x 10(9)/l (p at Mantel-Cox=0.029). Overall cumulative probability of survival at 1 yr was 0.38 (95% C.I. 0.27-0.49) and only the treatment with Amfotericin B significantly reduced the risk of death.