Candida glabrata is an increasing cause of
candidemia, especially at
cancer and bone marrow transplant centers where
fluconazole is used for antifungal prophylaxis. This yeast is less susceptible to
fluconazole in vitro than is Candida albicans. We compared the characteristics of patients who had C. glabrata and C. albicans
candidemia at a large
cancer center.
SUBJECTS AND METHODS: We searched the microbiological laboratory reports and identified 116 cases of C. glabrata
candidemia between 1993 and 1999. The 116 cases of C. albicans
candidemia that occurred most closely in time (before or after each case of C. glabrata
candidemia) served as the control group. Data were collected from patients' medical records.
RESULTS: When compared with patients who had C. albicans
infection, patients with C. glabrata
candidemia more often had an underlying
hematologic malignancy (68 [59%] vs. 26 [22%], P = 0.0001), had an Acute Physiology and Chronic Health Evaluation (APACHE) II score > or =16 (55 [48%] vs. 28 [25%], P = 0.0002), and received
fluconazole prophylaxis (57 [49%] vs. 8 [7%], P = 0.0001). Patients with C. albicans
candidemia more often had concomitant
infections (101 [87%] vs. 78 [67%], P = 0.0003) and septic
thrombophlebitis (11 [10%] vs. 2 [2%], P = 0.01). Among patients treated with antifungal
therapy, those with C. albicans
candidemia had a significantly greater overall response to
therapy (83/104 [80%] vs. 60/97 [62%], P = 0.005) and to primary
therapy (74/104 [71%] vs. 45/97 [46%], P = 0.0003).
Amphotericin B preparations were not more effective than
fluconazole (19/45 [42%] vs. 20/38 [53%], P = 0.5) in patients with C. glabrata
candidemia.
Fluconazole was less effective against C. glabrata than against C. albicans (20/38 [53%] vs. 57/74 [77%], P = 0.008).
CONCLUSION: