Table 1.
Demographic and clinical characteristics of the patients with breakthrough yeast bloodstream infections (cases) compared to those with de novo yeast bloodstream infections (controls).
| Characteristics | All patients | Cases | Controls | P |
|---|---|---|---|---|
| (n = 49) | (n = 21) | (n = 28) | ||
| Age, median years (IQR) | 58 (49–65) | 54 (50–63) | 62 (49–65) | .84 |
| Male sex | 26 (53) | 13 (62) | 13 (46) | .39 |
| Underlying hematological malignancy | .06 | |||
| Acute leukemia | 20 (41) | 13 (62) | 7 (25) | |
| Myelodysplastic syndrome | 8 (16) | 4 (19) | 4 (14) | |
| Lymphoma | 8 (16) | 2 (10) | 6 (21) | |
| Multiple myeloma | 7 (14) | 1 (5) | 6 (21) | |
| Othera | 6 (12) | 1 (5) | 5 (18) | |
| Treatment of hematological malignancy | .46 | |||
| Chemotherapy | 29 (59) | 14 (67) | 15 (54) | |
| Hematopoietic stem cell transplantation | 6 (12) | 3 (14) | 3 (11) | |
| Supportive therapy | 14 (29) | 4 (19) | 10 (36) | |
| Comorbidities | ||||
| Diabetes mellitus | 13 (27) | 7 (33) | 6 (21) | .51 |
| Chronic kidney disease | 2 (4) | 0 (0) | 2 (7) | .50 |
| Chronic liver disease | 3 (6) | 1 (5) | 2 (7) | 1.00 |
| Prior hospital stay, median days (IQR) | 15 (8–34) | 22 (15–35) | 11 (4–28) | .68 |
| Risk factors for yeast BSIsb | ||||
| ICU residence | 10 (20) | 3 (14) | 7 (25) | .48 |
| Corticosteroidc | 20 (41) | 10 (48) | 10 (36) | .56 |
| Surgery | 7 (14) | 4 (19) | 3 (11) | .44 |
| Hyperalimentation | 38 (78) | 17 (81) | 21 (75) | .74 |
| Central venous catheter | 44 (90) | 21 (100) | 23 (82) | .06 |
| Prior use of antibiotics | 46 (94) | 19 (91) | 27 (96) | .57 |
| Neutropenia in the 3 days prior to a yeast BSI | 30 (61) | 18 (86) | 12 (43) | <.01 |
| Prior azole exposure within 4 weeks prior to a yeast BSI | 20 (41) | 19 (91) | 1 (4) | <.01 |
| Pitt bacteremia score, median (IQR) | 1 (0–3) | 1 (0–2) | 1 (0–3) | .93 |
| Source of yeast BSIs | .19 | |||
| Central venous catheter | 21 (43) | 9 (43) | 12 (43) | |
| Gastrointestinal tract | 12 (24) | 7 (33) | 5 (18) | |
| Unknown | 10 (20) | 5 (24) | 5 (18) | |
| Otherd | 6 (12) | 0 (0) | 6 (22) | |
| Polymicrobial BSIse | 23 (47) | 12 (57) | 11 (39) | .26 |
| First-line antifungal agent | <.01 | |||
| Azole | 10 (20) | 1 (5) | 9 (32) | |
| Echinocandin | 11 (22) | 7 (33) | 4 (14) | |
| Polyene | 28 (57) | 13 (62) | 15 (54) | |
| Time to initiation of appropriate antifungal therapy for yeast BSIs, median days (IQR) | 2 (1–3) | 2 (1–4) | 2 (1–3) | .60 |
| Total duration of antifungal therapy for yeast BSIs, median days (IQR) | 18 (11–27) | 19 (13–30) | 18 (6–27) | .94 |
Note. Data are no. (%) of patients, unless otherwise indicated.
BSI, bloodstream infection; ICU, intensive care unit; IQR, interquartile range.
aSevere aplastic anemia (n = 3), hemophagocytic lymphohistiocytosis (n = 2), and chronic myeloid leukemia (n = 1).
bRisk factors within 30 days prior to a yeast bloodstream infection.
cMean minimum dose of 10 mg/day of prednisone equivalent for >14 days.
dGenitourinary tract (n = 5) and deep soft tissue (n = 1).
eIsolation of ≥2 different species of yeast or a yeast with concomitant bacterial species from blood cultures obtained within a 48-h period.