Treatment outcomes of anidulafungin in invasive fungal infections

Ref ID: 19209

Author:

R. Ong*, J. Teo, J.Y. Ng, K.Y. Lee, K. Patel, P. Chlebicki, S. Tang, W. Lee, A.L. Kwa

Author address:

Singapore, SG

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

Objectives: To characterize the prescribing practices of anidulafungin (AFG), and evaluate the efficacy and safety of its use in the treatment of documented invasive fungal infections (IFI).
Methods: A retrospective cohort study was conducted in Singapore General Hospital from January 2011 to October 2012 of all patients prescribed AFG for documented IFI. Demographics, clinical and microbiological data, and outcomes were collected.
Results: Twenty-nine patients received AFG for definitive IFI. Apart from a case of pulmonary aspergillosis, Candida spp. was the cause of all other IFI. These included 13 intra-abdominal infections, 9 candidemia, 5 osteomyelitis and 1 endovascular infection. Most patients (22) had IFI due to Candida non-albicans – C. tropicalis (11), C. glabrata (8), C. parapsilosis (1), C. haemulonii (1) and C. dubiniesis (2), while C. albicans were isolated in only 10 cases. Infections with >= 2 Candida spp. were seen in 5 patients. AFG was the initial choice of antifungal in 17 cases in view of severe sepsis (7), azole-resistance (6), severe hepatic impairment (7) and avoidance of drug interaction (1). However, the choice of AFG was deemed inappropriate in 3 cases as patients were clinically stable and had azole-susceptible isolates. In 9 cases, AFG was converted from fluconazole in view of fluconazole-induced transaminitis (3), azole-resistance (3) and treatment failure (1 case of aspergillosis with clinical deterioration and 3 cases with clinical and/or radiological worsening). Four patients were converted from caspofungin to AFG due to liver impairment (3) and physician preference (1).
Favourable efficacy outcome was documented in 20/27 (74%) patients. Three patients showed minor/no improvement, whereas 4 worsened on AFG. Recurrent IFIs following antifungal therapy was suspected in 3 cases. Poor source control was likely the cause of recurrence in 2 of these cases, rather than antifungal failure. Mortality occurred in 17/27 cases and 4 were possibly attributable to IFI. No adverse drug events were observed, even with prolonged therapy of 249 days. Safety in severe baseline liver impairment was also demonstrated – 11/12 such cases had stable/improving liver function on AFG.
Conclusion: AFG was well tolerated and effective in the treatment of documented various IFI caused by a variety of Candida spp..

Abstract Number: P1003

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=165735&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

New link: NULL

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