Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis

Objectives: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30 -day survival and compare it with continuing the treatment with echinocandins (non -DES). Metho...

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Autores: Albanell-Fernández, M, González, FS, Pérez, OM, Aniyar, V, Hueso, FJC, Soriano, A, García-Vidal, C, Puerta-Alcalde, P, Martínez, JA, Ferreiro, PV
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2024
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p17986
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/17986
Access Level:acceso abierto
Palabra clave:30-day survival
Azoles
Candida
De-escalation
Echinocandins
Meta-analysis
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spelling Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysisAlbanell-Fernández, MGonzález, FSPérez, OMAniyar, VHueso, FJCSoriano, AGarcía-Vidal, CPuerta-Alcalde, PMartínez, JAFerreiro, PV30-day survivalAzolesCandidaDe-escalationEchinocandinsMeta-analysisObjectives: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30 -day survival and compare it with continuing the treatment with echinocandins (non -DES). Methods: We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random -effects model. Heterogeneity was explored stratifying by subgroups and via meta -regression. This systematic review is registered with PROSPERO (CRD42023475486). Results: Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies steppeddown to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30 -day survival 2.17 (95% CI: 1.09-4.32). The 30 -day survival data into subgroups showed higher effect on critically ill patients and serious -risk bias studies. Meta -regression did not identify significant effect modifiers. Conclusions: DES is a safe strategy; it showed no higher 30 -day mortality and a trend towards greater clinical and microbiological cure. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY -NC -ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )ELSEVIER SCI LTD2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/17986INTERNATIONAL JOURNAL OF INFECTIOUS DISEASESISSN: 12019712ISSNe: 18783511reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p179862026-06-11T12:45:17Z
dc.title.none.fl_str_mv Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
title Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
spellingShingle Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
Albanell-Fernández, M
30-day survival
Azoles
Candida
De-escalation
Echinocandins
Meta-analysis
title_short Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
title_full Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
title_fullStr Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
title_full_unstemmed Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
title_sort Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis
dc.creator.none.fl_str_mv Albanell-Fernández, M
González, FS
Pérez, OM
Aniyar, V
Hueso, FJC
Soriano, A
García-Vidal, C
Puerta-Alcalde, P
Martínez, JA
Ferreiro, PV
author Albanell-Fernández, M
author_facet Albanell-Fernández, M
González, FS
Pérez, OM
Aniyar, V
Hueso, FJC
Soriano, A
García-Vidal, C
Puerta-Alcalde, P
Martínez, JA
Ferreiro, PV
author_role author
author2 González, FS
Pérez, OM
Aniyar, V
Hueso, FJC
Soriano, A
García-Vidal, C
Puerta-Alcalde, P
Martínez, JA
Ferreiro, PV
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv 30-day survival
Azoles
Candida
De-escalation
Echinocandins
Meta-analysis
topic 30-day survival
Azoles
Candida
De-escalation
Echinocandins
Meta-analysis
description Objectives: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30 -day survival and compare it with continuing the treatment with echinocandins (non -DES). Methods: We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random -effects model. Heterogeneity was explored stratifying by subgroups and via meta -regression. This systematic review is registered with PROSPERO (CRD42023475486). Results: Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies steppeddown to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30 -day survival 2.17 (95% CI: 1.09-4.32). The 30 -day survival data into subgroups showed higher effect on critically ill patients and serious -risk bias studies. Meta -regression did not identify significant effect modifiers. Conclusions: DES is a safe strategy; it showed no higher 30 -day mortality and a trend towards greater clinical and microbiological cure. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY -NC -ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )
publishDate 2024
dc.date.none.fl_str_mv 2024
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://fisabio.portalinvestigacion.com/publicaciones/17986
url https://fisabio.portalinvestigacion.com/publicaciones/17986
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER SCI LTD
publisher.none.fl_str_mv ELSEVIER SCI LTD
dc.source.none.fl_str_mv INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
ISSN: 12019712
ISSNe: 18783511
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812455

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