AML-330 Management of Candida Krusei Candidemia in Patients With Acute Myeloid Leukemia

Abstract

Candidemia represents 10% of nosocomial infections in hospitalized patients and is associated with mortality described to be as high as 40%. Underlying immune defect, solid or hematological malignancy, may predispose patients to candidemia, which develops during the clinical course of these conditions in 1.8% of cases. The aim of our study is to evaluate the therapeutic management of candidemia due to Candida krusei in our patients. It is a retrospective study over 1 year from January to December 2021, including all patients with AML hospitalized on the protected side of our service who presented an episode of febrile neutropenia and in whom a blood culture was positive for Candida krusei. Of 140 patients hospitalized on the protected side, 36 patients presented with candidemia due to Candida krusei, i.e., 26% of patients. The median age was 42 years (IQR 19-81), and 21 (58%) were male. All our patients had, as risk factors for developing candidemia, hematological malignancy, severe neutropenia <500 NPN, antibiotic prophylaxis based on ciprofloxacin, and antifungal prophylaxis based on fluconazole. Six patients had a central venous catheter (16%), and the EQUAL score was between 8 and 10 for all our patients. The total number of blood cultures performed is, on average, 5 per patient; on the antifungiogram, all Candida krusei isolated were sensitive to amphotericin B and resistant to fluconazole. All our patients were treated with voriconazole, and only one patient benefited from amphotericin B, with a good evolution in 19 patients (53%) and an evolution towards septic shock in 17 (47%) patients, of whom 7 evolved well and 10 died, i.e., 28% of the total infected patients. Our results confirm the high mortality of candidemia in patients with hematological malignity due to the variety of risk factors to which they are exposed as well as the difficulty of their management. The EQUAL score assigns a numerical value to compliance with specific guideline recommendations, allowing for better management and care of patients with candidemia in our care structure.