951. Non-Candida yeast Bloodstream infections (NCYBIs) in Cancer Patients (pts)
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: NCYBIs are rare, even in cancer pts. We describe our recent experience with NCYBIs in our cancer center.

Methods: All episodes of NCYBIs occurring over a 13-year period (1998-2010) were retrospectively reviewed. We excluded Cryptococcus spp. We categorized NCYBIs into catheter related bloodstream infection (CRBSI) or not.

Results: 2984 blood cultures (BC) positive for Candida and NCY were identified. Among them, 94(3%) positive BC for NCY representing 41 episodes of NCYBIs (41pts) were reviewed. The median age of pts were 51 y(8-81), 51 % were males. Most pts had leukemia or lymphoma (27, 66%); 12(29%) pts underwent HSCT. Most pts (23, 56%) had received prior steroids and neutropenia was seen in 20(49%)pts. Fungemia occurred in ICU in 16(39%)pts. Breakthrough NCYBIs occurred in 20(49%), (during azole therapy in 12, during echinocandin(ECD) in 5 and LipoAMB in 3 pts). Implicated yeasts spp were Rhotodotula 21(51%), Trichosporon 8(20%), Saccharomyces 8(20%), Geotrichum 2(5%), Pichia and Malassesia(1 pt each). CRBSI was diagnosed in 21/39(54%) pts. CVC was removed in 26/39(66%) pts. Antifungal treatment was given in 35/41(85%)pts, (lipoAMB in 15 pts, ECD in 12 pts and azoles in 8 pts). Of the 33/41 yeast isolates tested in vitro (NCCLS method), all Trichosporon, Geotrichum and Pichia isolates were azole susceptible (S). All Saccharomyces isolates were S to voriconazole and posaconazole but 25% were resistant (R) to fluconazole. For Rhodotorula spp, R rate to fluconazole, itraconazole, posaconazole and voriconazole were 82%, 65%, 45% and 36%, respectively. AMB S to Saccharomyces, Rhodotorula, Trichosporon, and Geotrichum were 100%, 88%, 60%, and 50% respectively. ECD R was noted in all Trichosporon, Geotrichum and Rhodotorula isolates; all Saccharomyces isolates were S to ECD. Fatal disseminated infection occurred in 6(15%)pts; 5 were neutropenic. Of 4/9(44%) pts without resolution of neutropenia died of disseminated infection. Crude mortality at 30 days was 14/41(34%).

Conclusion: NCYBIs remain infrequent in cancer patients, and catheters are common source. Half of NCYBIs occurred as breakthrough infections and in vitro resistance to antifungals was not uncommon. Disseminated infection resulted in high mortality rate.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Maria N. Chitasombat, MD, Infectious Department, The University of Texas Health Science Center at Houston , Houston, TX, Russell Lewis, PharmD, The University of Texas M.D. Anderson Cancer Center , Houston, TX, Diamantis Kofteridis, MD, The University of Texas MD Anderson Cancer Center , Houston, TX and Dimitrios Kontoyiannis, MD, ScD, FACP, FIDSA, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Disclosures:

M. N. Chitasombat, None

R. Lewis, None

D. Kofteridis, None

D. Kontoyiannis, None

See more of: Clinical Mycology
See more of: Poster Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.