971. The clinical impact of breakthrough candidemia at a territorial hospital in Japan
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
  • (Candida+A学会).pdf (331.3 kB)
  • Background: 

    Breakthrough candidemia is associated with significant patient mortality and morbidity.


    We reviewed the medical records of patients at Toranomon Hospital (890 beds, Tokyo, Japan) with breakthrough candidemia during 2000 to 2011. The breakthrough candidemia is defined as candidemia that develops during administration of antifungal agents. The identification of breakthrough Candida species was performed using VITEK and VITEK 2. The drug susceptibility test was performed to use a commercially prepared colorimetric microdilution panel. The results of the test appeared to be comparable to those obtained by the CLSI M27 - A2 method.


    Among 153 candidemia patients (58 Candia aibicans and 95 non-albicans Candida) examined, 14 had breakthrough candidemia. All 14 patients with breakthrough candidemia had hematological disorders; 12 patients had received hematopoietic stem cell transplantation. The species isolated were C. parapsilosis (6 cases), C. glabrata (3 cases), C. krusei (2 cases), C. guilliermondii (1 case), C.albicans (1 case) and C. lusitaniae (1 case). The antifungal agents used when breakthrough candidemia developed were fluconazole (1 case), itraconazole(1 case), voriconazole(1 case), micafungin (8 cases), and liposomal amphotericin B (3 cases). Sites of infection were central venous catheter in 4, lung in 2, intraabdominal in 1, but the sites were unknown in 7. In 3 of the 4 patients with central venous catheter infection with micafungin administration, the infection was caused by C.parapsilosis, and these patients were successfully treated by removal of the catheter and changing the antifungal agents. The 28-day mortality rate of patients with breakthrough candidemia was 43%.The drug susceptibility test was performed for nine cases. Susceptibility for administered agents when breakthrough candidemia developed was susceptible to resistant.


    Clinicians should note that breakthrough candidemia may occur in patients with hematological disorders even if the causative Candida species are susceptible to the prophylactic antifungal agents. Therapeutic strategies for breakthrough candidemia may be early catheter removal and changing the class of antifungal agents administered.

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

    Muneyoshi Kimura, MD, Hideki Araoka, MD, Masaru Baba and Akiko Yoneyama, MD, Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan


    M. Kimura, None

    H. Araoka, None

    M. Baba, None

    A. Yoneyama, None

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