Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome.

Abstract

We reviewed 135 cases of candidemia occurring between 1983 and 1986 to examine oncologic and nononcologic populations and assess factors for survival. Candida albicans was the most common species (51%); Candida tropicalis occurred most frequently in leukemia patients (57%), whereas Candida parapsilosis and Torulopsis glabrata were associated with solid tumors and nononcologic diseases. Risk factors identified were: preceding surgery, antibiotics, cannulas, and steroids in solid tumor and nononcologic diseases; and chemotherapy and neutropenia with hematologic malignancies. Even transient cannula-associated candidemia was not a benign process. Intravenous cannulas were common portals of entry (39%) in debilitated patients without cancer (59%) and were associated with high mortality (55%). Overall mortality was 59%, candidemia directly contributing to death in 75% of cases. In patients with candidemia, failure to initiate therapy with amphotericin B had a negative influence on outcome, whereas analysis of the entire group identified severity of underlying illness as the dominant cofactor influencing outcome.