Background: Few studies found differences in mortality according to the different therapeutic strategies for patients with candidemia. Moreover, variables related to the length of antifungal therapies are poorly investigated. Objective of the study was to evaluate the impact of 4 different therapeutic strategies on survival and to identify variables correlated to length of antifungal therapy in patients with candidemia
Material/methods: Prospective, monocenter, cohort study. An inpatient ID consultation team was implemented in 11/2012 in a 1100-bed university hospital in Rome, Italy (Catholic University of Rome), with the goal of optimizing antiinfective treatment. Data for every consultation were prospectively collected by the team using a standardized database. Only patients with at least one blood culture in which Candida was isolated were included in the study. Patients with candidemia in Intensive Care Unit and Haematology were excluded. Antifungal treatment strategies were stratified as: 1) fluconazole (Fluc); 2) fluconazole at starting and then escalation (Escal); 3) echinocandin or liposomial amphotericin B (Echin_AmfB); 4) echinocandin or liposomial amphotericin B at starting and then deescalation to fluconazole (De-escal). A Cox regression analysis were used to evaluate the correlation between variables and length of therapy.
Results: At 30/04/2015, 205 patients with candidemia were observed. Median age: 70 yrs (IQR 60- 79); 56% males. Mean APACHE II: 15.4 (SD 6.6). 71% had a CVC. C. albicans was isolated in 60.5% of cases. In 170 cases the clinical presentation was a SIRS or severe sepsis and in 20 a septic shock. 33% of patients had a concomitant bacterial isolation in blood cultures. In 26.8 the antifungal strategy was Fluc, in 16.1% Escal, in 28.8% Echin_AmfB and in 26.8% De-escal. 85 patients (41.5%) died during follow-up. Mean of antifungal therapy was 19.5 days (SD 13.0) in Fluc, 33.4 (SD 24.7) in Escal, 15.5 (SD 12.7) in Echin_AmfB and 27.2 (SD 19.5) in De-escal group (p at ANOVA <0.001). No significant differences were found for length of hospitalization and 30-days survival. In Table variables correlated to length of therapy (excluding patients with corioretinitis).
Conclusions: In patients with candidemia, type of therapeutic strategy was not correlated to survival while lenght of therapy in the Descal group and Escal was significantly higher compared to Fluc or Echin_AmfB
Full conference title:
- ECCMID 26th (2016)