Fluconazole versus an echinocandin for Candida glabrata fungaemia: A retrospective cohort study
Journal
Journal of Antimicrobial Chemotherapy
Journal Volume
68
Journal Issue
4
Pages
922-926
Date Issued
2013
Author(s)
Eschenauer G.A.
Carver P.L.
Klinker K.P.
Potoski B.A.
Shields R.K.
Clancy C.J.
Nguyen M.-H.
Lam S.W.
Abstract
Objectives: We studied whether fluconazole or echinocandin treatment of Candida glabrata fungaemia results in superior outcomes. Methods: A multicentre, retrospective study was performed with 224 adult patients who received ?5 days of therapy with either fluconazole or an echinocandin as their first antifungal treatment after collection of a blood culture that grew C. glabrata. The primary outcome was day 14 complete response. Results: Patients in the echinocandin group were generally more ill, both at baseline and at the time of the index culture. Day 14 complete response was obtained in 58/127 (46%) and 50/97 (52%) of the fluconazole and echinocandin patients, respectively (P0.383). Logistic regression found intensive care unit admission to be associated with failure [OR 0.456 (0.217-0.957), P0.038] and echinocandin therapy to be associated with day 14 complete response [OR 2.305 (1.124-4.727), P0.023]. Twenty-eight day survival was similar between the fluconazole and echinocandin groups and logistic regression did not reveal antifungal therapy choice to be independently predictive of mortality. For patients treated with fluconazole, a dose:MIC ratio>12.5 (when compared with a ratio ?12.5) was associated with a significantly higher day 14 complete response [4/20 (20%) ?12.5 versus 50/102 (49%)>12.5, P0.025]. Conclusions: Severity of illness and choice of antifungal predict response in patients with C. glabrata fungaemia. Antifungal choice, however, does not influence mortality. In addition, new CLSI C. glabrata fluconazole susceptibility breakpoints are predictive of response when fluconazole is dosed appropriately.
Other Subjects
echinocandin; fluconazole; adult; article; Candida glabrata; candidiasis; drug treatment failure; female; fungus culture; fungus growth; human; intensive care unit; major clinical study; male; minimum inhibitory concentration; mortality; multicenter study; nonhuman; pharmacodynamics; retrospective study; survival; treatment outcome; treatment response; Adult; Aged; Aged, 80 and over; Antifungal Agents; Candida glabrata; Candidemia; Cohort Studies; Echinocandins; Female; Fluconazole; Humans; Male; Middle Aged; Retrospective Studies; Survival Analysis; Treatment Outcome
Type
journal article