Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis

Background: Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relatio...

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Autores: Falcone, Marco, Tiseo, Giusy, Gutiérrez Gutiérrez, Belén, Raponi, Giammarco, Carfagna, Paolo, Rosin, Chiara, Luzzati, Roberto, Rose, Diego Delle, Andreoni, Massimo, Farcomeni, Alessio, Venditti, Mario, Rodríguez-Baño, Jesús, Menichetti, Francesco
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/176141
Acceso en línea:https://hdl.handle.net/11441/176141
https://doi.org/10.1093/ofid/ofz251
Access Level:acceso abierto
Palabra clave:Candidemia
Early antifungal therapy
Echinocandins
Septic shock
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spelling Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted AnalysisFalcone, MarcoTiseo, GiusyGutiérrez Gutiérrez, BelénRaponi, GiammarcoCarfagna, PaoloRosin, ChiaraLuzzati, RobertoRose, Diego DelleAndreoni, MassimoFarcomeni, AlessioVenditti, MarioRodríguez-Baño, JesúsMenichetti, FrancescoCandidemiaEarly antifungal therapyEchinocandinsSeptic shockBackground: Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock. Methods: Patients with candidemia hospitalized in internal medicine wards of 5 tertiary care centers were included in the study (December 2012–December 2014). Patient characteristics, therapeutic interventions, and outcome were reviewed. Propensity score (PS) was used as a covariate of the multivariate analysis to perform a stratified analysis according to PS quartiles and to match patients receiving “echinocandins” or “azoles.” Results: Overall, 439 patients with candidemia were included in the study. A total of 172 (39.2%) patients had septic shock. Thirty-day mortality was significantly higher in patients with septic shock (45.3%) compared with those without septic shock (31.5%; P = .003). Among patients with septic shock, the use of echinocandins in the first 48 hours, compared with azoles, did not affect 30-day mortality in the PS-adjusted Cox regression analysis (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.37–1.59; P = .48), the PS-stratified analysis, or the logistic regression model in matched cohorts (adjusted HR, 0.92; 95% CI, 0.51–1.63; P = .77). Conclusions: Echinocandin therapy seems not to improve the outcome of non–intensive care unit patients with septic shock due to candidemia. These findings support the urgent need of further studies in this patient population.Oxford University PressMedicina2019info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/176141https://doi.org/10.1093/ofid/ofz251reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésOpen Forum Infectious Diseases, 6 (7), ofz251.https://academic.oup.com/ofid/article/6/7/ofz251/5532720#google_vignetteinfo:eu-repo/semantics/openAccessoai:idus.us.es:11441/1761412026-06-17T12:51:07Z
dc.title.none.fl_str_mv Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
title Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
spellingShingle Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
Falcone, Marco
Candidemia
Early antifungal therapy
Echinocandins
Septic shock
title_short Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
title_full Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
title_fullStr Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
title_full_unstemmed Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
title_sort Impact of Initial Antifungal Therapy on the Outcome of Patients With Candidemia and Septic Shock Admitted to Medical Wards: A Propensity Score–Adjusted Analysis
dc.creator.none.fl_str_mv Falcone, Marco
Tiseo, Giusy
Gutiérrez Gutiérrez, Belén
Raponi, Giammarco
Carfagna, Paolo
Rosin, Chiara
Luzzati, Roberto
Rose, Diego Delle
Andreoni, Massimo
Farcomeni, Alessio
Venditti, Mario
Rodríguez-Baño, Jesús
Menichetti, Francesco
author Falcone, Marco
author_facet Falcone, Marco
Tiseo, Giusy
Gutiérrez Gutiérrez, Belén
Raponi, Giammarco
Carfagna, Paolo
Rosin, Chiara
Luzzati, Roberto
Rose, Diego Delle
Andreoni, Massimo
Farcomeni, Alessio
Venditti, Mario
Rodríguez-Baño, Jesús
Menichetti, Francesco
author_role author
author2 Tiseo, Giusy
Gutiérrez Gutiérrez, Belén
Raponi, Giammarco
Carfagna, Paolo
Rosin, Chiara
Luzzati, Roberto
Rose, Diego Delle
Andreoni, Massimo
Farcomeni, Alessio
Venditti, Mario
Rodríguez-Baño, Jesús
Menichetti, Francesco
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
dc.subject.none.fl_str_mv Candidemia
Early antifungal therapy
Echinocandins
Septic shock
topic Candidemia
Early antifungal therapy
Echinocandins
Septic shock
description Background: Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock. Methods: Patients with candidemia hospitalized in internal medicine wards of 5 tertiary care centers were included in the study (December 2012–December 2014). Patient characteristics, therapeutic interventions, and outcome were reviewed. Propensity score (PS) was used as a covariate of the multivariate analysis to perform a stratified analysis according to PS quartiles and to match patients receiving “echinocandins” or “azoles.” Results: Overall, 439 patients with candidemia were included in the study. A total of 172 (39.2%) patients had septic shock. Thirty-day mortality was significantly higher in patients with septic shock (45.3%) compared with those without septic shock (31.5%; P = .003). Among patients with septic shock, the use of echinocandins in the first 48 hours, compared with azoles, did not affect 30-day mortality in the PS-adjusted Cox regression analysis (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.37–1.59; P = .48), the PS-stratified analysis, or the logistic regression model in matched cohorts (adjusted HR, 0.92; 95% CI, 0.51–1.63; P = .77). Conclusions: Echinocandin therapy seems not to improve the outcome of non–intensive care unit patients with septic shock due to candidemia. These findings support the urgent need of further studies in this patient population.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/176141
https://doi.org/10.1093/ofid/ofz251
url https://hdl.handle.net/11441/176141
https://doi.org/10.1093/ofid/ofz251
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Open Forum Infectious Diseases, 6 (7), ofz251.
https://academic.oup.com/ofid/article/6/7/ofz251/5532720#google_vignette
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Oxford University Press
publisher.none.fl_str_mv Oxford University Press
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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