Risk factors and outcome for breakthrough candidaemia in patients with cancer

Summary While candidaemia that develops during systemic antifungal prophylaxis or therapy [breakthrough (BT) candidaemia] has been reported increasingly, the risk factors and outcome of BT candidaemia are not yet known definitely. We evaluated a consecutive series of cancer patients with candidaemia at Asan Medical Center during 6 years to identify risk factors and outcome in BT candidaemia comparing with non‐BT candidaemia. Fifty‐four episodes of candidaemia in cancer patients diagnosed during this period were reviewed retrospectively. There were 10 episodes (18.5%) of BT candidaemia in which the species distribution and frequency of catheter‐related infection in the BT and non‐BT groups were similar. BT candidaemia had a tendency to occur more frequently in patients with haematological than non‐haematological diseases. Profound neutropenia and disseminated candidiasis were more common in the BT group; however, these differences were not statistically significant ( P  = 0.17 and 0.07 respectively). The duration of prior antibiotic therapy and duration of profound neutropenia (<100 mm −3 ) were identified as risk factors for BT candidaemia ( P  < 0.01 and 0.02 respectively) in univariate analysis and the latter was the only risk factor in multivariate analysis. The death rates due to candidaemia were 85.7% in the BT group and 42.9% in the non‐BT group ( P  = 0.08); however, BT candidaemia alone did not increase mortality rate.