Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia

There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection. This is a multicenter post hoc study that inclu...

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Autores: Moreno-García, Estela, Puerta-Alcalde, Pedro|||0000-0003-2490-0217, Gariup, Giuseppe, Fernández-Ruiz, Mario, López Cortés, Luis Eduardo|||0000-0002-9347-527X, Cuervo, Guillermo|||0000-0002-7075-943X, Salavert, Miguel|||0000-0002-8571-2124, Merino, Paloma, Machado, Marina|||0000-0002-8370-2248, Guinea, Jose, García-Rodríguez, Julio, Garnacho Montero, José|||0000-0003-2542-7601, Cardozo, Celia, Peman, Javier, Montejo, Miguel, Fortún, Jesús|||0000-0002-6959-5263, Almirante Gragera, Benito|||0000-0002-1189-2361, Castro, Carmen, Rodríguez-Baño, Jesús|||0000-0001-6732-9001, Aguado, José María|||0000-0002-9520-8255, Martínez, Jose Alfredo, Carratalà, Jordi|||0000-0003-3209-2563, Soriano Viladomiu, Alex|||0000-0002-9374-0811, Garcia-Vidal, Carolina|||0000-0002-8915-0683
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:243341
Acceso en línea:https://ddd.uab.cat/record/243341
https://dx.doi.org/urn:doi:10.1093/ofid/ofab250
Access Level:acceso abierto
Palabra clave:Antifungal
Candidemia
De-escalation
Invasive candidiasis
Outcome
Descripción
Sumario:There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection. This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (2007-2016). The impact of ED and factors associated with mortality were assessed. Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P = .006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P = .043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P = .016), and candidemia from an unknown source (24.1% vs 47%; P = .003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P = .006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48-10.61), Pitt score.

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