A retrospective analysis of voriconazole for treatment of invasive candida glabrata infections at a university teaching hospital

Brown J 1,2,3, Low J 2,4

Author address: 

1 Deparment of Infectious Disease, Dartmouth Hitchcock Medical Center, Lebanon USA, 2 Deptartment of Pharmacy, Dartmouth Hitchcock Medical Center , Lebanon USA, 3 Department of Internal Medicine, Dartmouth Medical College, Lebanon USA, 4 Department

Abstract: 

Candia glabrata is the second most common species of invasive candida seen in clinical practice. Early generation azole antifungals have in-vitro dose dependent or fulminate resistance to this species of candida. To date, published clinical information evaluating voriconazole for the treatment of C. glabrata is scant. The purpose of this study was to retrospectively compare the microbiological and clinical outcomes of patients treated with voriconazole versus those treated with other licensed antifungal therapy (OLAT) for documented invasive C. glabrata infections. The inclusion criteria was all patients between January, 1999 and November 2004 who received > 2 doses of voriconazole or > 2 doses of OLAT for the treatment of documented invasive C. glabrata infections. OLAT in this study was considered: caspofungin, amphotericin-B, Liposomal amphotericin-B, amphotericin-B lipid complex, fluconazole or itraconazole. Patients must have had positive culture results for C. glabrata and at least one clinical sign of infection. Outcome evaluation was based on: microbiological eradication or persistence, overall mortality and clinical response (fever, WBC), length of hospitalization, admission to the ICU and mortality. APACHE II scores were also calculated at baseline to evaluate severity of illness. A total of 65 C. glabrata treatment courses were documented in 52 patients, 16 of which received voriconazole and 49 who were treated with OLAT. Initial therapy was subsequently changed in 13 patients, including 2 from OLAT to voriconazole ,1 from voriconazole to OLAT and 10 from OLAT to OLAT. Invasive infections included fungemia (n=19), intrabdomenal infections (n=30) and others(n=3). Voriconazole treatment regimens included 7 fungemias, 8 intrabdomenal infections and 1 empyema. The overall eradication rate was 89% for voriconazole and 53% for OLAT (p=0.1). Eradication rate and time to eradication for fungemias was 100% (7/7) and 4.5 days for voriconazole treated patients and 64% (7/11) (p
2005

abstract No: 

32

Full conference title: 

15th Annual Focus on Fungal Infections
    • FFI 15th (2005)