Physician Management of Candida glabrata Fungemia and Outcome Based on Choice of Therapy

VIJAYALAKSHMI NAGAPPAN, MD, RAMAMANOHARA PAI, MD, TEJAL MEHTA, MD, LEONARD JOHNSON, MD;

Author address: 

St John Hospital and Medical Center, Grosse Pointe Woods, MI.

Abstract: 

Background: Use of fluconazole (FLU) in treatment of candidemia has been questioned due to variations in in-vitro susceptibilities of different Candida species to FLU. Significance of in-vitro differences on patient outcomes and efficacy of FLU for C. glabrata fungemia (Cg) remains unknown. The objective was to determine how frequently antifungal treatment is changed among patients diagnosed with Cg; and to evaluate outcome of patients with Cg, treated with FLU regimen (FR) vs non-FLU regimen (NFR). Methods: Patients with candidemia at St. John Hospital were identified by review of microbiology from February 2003 until February 2006. Following data was collected on patients with Cg: age, gender, comorbid illness, risk factors for candidemia, duration of infection, antifungal therapy (dose, duration and changes made in response to culture results), and patient outcomes. Cg patients were compared with age and gender matched control patients with C. albicans fungemia (Ca). Results: Among 152 patients with candidemia identified from 2/038722;2/06, 37 (24.3%) had Cg and 73 (48.0%) had Ca. Among patients with Cg, 28 had charts available for review. Two of the 28 were excluded (both died within 48 hours of diagnosis). 26 patients with Cg were compared with 12 Ca controls. Both groups were similar in terms of underlying characteristics. Most patients in both groups were initially treated with FLU (84.6% in Cg versus 91.7% in Ca). Treatment regimen was changed to NFR more frequently in the Cg group than Ca group (40.9% vs. 0, p = 0.013). Among 26 Cg patients, patients who were treated with NFR tended to be younger (44.9±8.8 years vs. 66.5±3 years; p = 0.035) and had a longer duration of candidemia (9.6±2.5 days vs. 1.9±0.5 days, p = 0.01) than those treated with FR. There was no difference in outcomes among patients with Cg based on therapy (FR vs. NFR). Conclusion: Patients with Cg were more likely than those with Ca to have therapy changed to NFR. Among patients with Cg, there was no difference in patient outcomes based on therapy with FLU vs. NFR.
2006

abstract No: 

545

Full conference title: 

Infectious Diseases Society of America, 44th Annual Meeting
    • IDSA 44th