1524. The clinical and microbiological characteristics of breakthrough candidemia in an allogeneic hematopoietic stem cell transplantation setting
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: The aim of this study was to evaluate the clinical and microbiological characteristics ofbreakthrough candidemia (BC) in an allogeneic hematopoietic stem cell transplantation (allo-HSCT) setting. 

Methods: We reviewed the medical records and microbiological records of patients who received allo-HSCT between December 2008 and November 2012 at Toranomon Hospital (890 beds, Tokyo, Japan).  BC was defined as candidemia that developed upon the administration of anti-fungal agents.  Candida species were identified using Vitek and Vitek2 systems.  The drug susceptibility test was performed using a commercially prepared colorimetric microdilution panel.  The test appeared to be comparable to the CLSI M27-A2 method.  The level of (1,3)-beta-D-gulcan (BG) monitoring was performed for all the recipients once a week by using the beta-D-glucan kit (Wako, Japan).     

Results: During the study period, 514 episodes received allo-HSCT.  These stem sell sources were cord blood (361 epsodes), bone marrow (101 episodes), and peripheral blood (51 episodes).  Among 514 episodes, 21 were identified as BC episodes.  Eighteen of the 21 episodes received cord blood transplantation.  Additionally, 19 out of the 21 episodes occurred as BC within 100 days after receiving allo-HSCT.  The following species were isolated: C. parapsilosis (6), C. glabrata (6), C. guilliermondii(3), and other Candida species (6).  The 30 day mortality rate of BC was 38%.  The anti-fungal agents used when BC developed were micafungin (12 episodes), liposomal amphotericin B (4 episodes), itraconazole (3 episodes), and voriconazole (2 episodes).  The sites of infection were central venous catheter infection (5 episodes) and unknown (16 episodes).  Susceptibility for administered agents when breakthrough occurred ranged from susceptible to resistant.  The BG levels of 10 patients (10/21) were below the cut-off level ( < 11 pg/mL).  

Conclusion: To our knowledge, this is the first report describing the characteristics of BC in an allo-HSCT setting.  Clinicians should pay attention to the fact that BC could develop in allo-HSCT recipients under administrating prophylactic anti-fungal agents based on current guidelines.   Additionally, BG monitoring strategy might not be sufficient in detecting BC in this setting.

Muneyoshi Kimura, MD1, Hideki Araoka, MD1, Masahiro Abe, MD1, Daisuke Kaji, MD2, Hikaru Ota, MD2, Kazuya Ishiwata, MD2, Masanori Tsuji, MD2, Hisashi Yamamoto, MD2, Go Yamamoto, MD2, Yuki Asano-Mori, MD2, Naoyuki Uchida, MD2, Koji Izutsu, MD2, Shuichi Taniguchi, MD2 and Akiko Yoneyama, MD1, (1)Department of Infectious Diseases, Toranomon Hospital, Tokyo, Japan, (2)Department of Hematology, Toranomon Hospital, Tokyo, Japan

Disclosures:

M. Kimura, None

H. Araoka, None

M. Abe, None

D. Kaji, None

H. Ota, None

K. Ishiwata, None

M. Tsuji, None

H. Yamamoto, None

G. Yamamoto, None

Y. Asano-Mori, None

N. Uchida, None

K. Izutsu, None

S. Taniguchi, None

A. Yoneyama, None

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