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Initial antifungal strategy does not correlate with mortality in patients with candidemia

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The incidence of Candida bloodstream infections (BSIs) has increased over time, especially in medical wards. The objective of this study was to evaluate the impact of different antifungal treatment strategies on 30-day mortality in patients with Candida BSI not admitted to intensive care units (ICUs) at disease onset. This prospective, monocentric, cohort study was conducted at an 1100-bed university hospital in Rome, Italy, where an infectious disease consultation team was implemented. All cases of Candida BSIs observed in adult patients from November 2012 to April 2014 were included. Patients were grouped according to the initial antifungal strategy: fluconazole, echinocandin, or liposomal amphotericin B. Cox regression analysis was used to identify risk factors significantly associated with 15-day and 30-day mortality. During the study period, 130 patients with candidemia were observed (58 % with C. albicans, 7 % with C. glabrata, and 23 % with C. parapsilosis). The first antifungal drug was fluconazole for 40 % of patients, echinocandin for 57.0 %, and liposomal amphotericin B for 4 %. During follow-up, 33 % of patients died. The cumulative mortality 30 days after the candidemia episode was 30.8 % and was similar among groups. In the Cox regression analysis, clinical presentation was the only independent factor associated with 15-day mortality, and Acute Physiology and Chronic Health Evaluation (APACHE) II score and clinical presentation were the independent factors associated with 30-day mortality. No differences in 15-day and 30-day mortality were observed between patients with and without C. albicans candidemia. In patients with candidemia admitted to medical or surgical wards, clinical severity but not the initial antifungal strategy were significantly correlated with mortality.

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Acknowledgments

We are grateful to Leonida Passeri for his technical assistance in the data management.

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Authors and Affiliations

  1. Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy

    R. Murri, G. Scoppettuolo, G. Ventura, M. Fabbiani, F. Giovannenze, F. Taccari, E. Milozzi, R. Cauda & M. Fantoni

  2. Institute of Public Health, Section of Hygiene, Catholic University of Rome, Rome, Italy

    B. Posteraro

  3. Institute of Microbiology, Catholic University of Rome, Rome, Italy

    M. Sanguinetti

Authors
  1. R. Murri
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  2. G. Scoppettuolo
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  3. G. Ventura
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  4. M. Fabbiani
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  5. F. Giovannenze
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  6. F. Taccari
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  7. E. Milozzi
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  9. M. Sanguinetti
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  10. R. Cauda
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  11. M. Fantoni
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Correspondence to R. Murri.

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The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

The present manuscript was revised by San Francisco Edit, which was supported by internal funding.

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Murri, R., Scoppettuolo, G., Ventura, G. et al. Initial antifungal strategy does not correlate with mortality in patients with candidemia. Eur J Clin Microbiol Infect Dis 35, 187–193 (2016). https://doi.org/10.1007/s10096-015-2527-2

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  • DOI: https://doi.org/10.1007/s10096-015-2527-2

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