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Título: | Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies |
Autor: | Moreno-García, E.; Puerta-Alcalde, Pedro; Gariup, G.; Fernández-Ruiz, Mario; López-Cortés, Luis Eduardo; Cuervo, Guillermo; Salavert, Miguel; Merino, Paloma; Machado, Marina; Guinea, J.; García-Rodríguez, J.; Garnacho-Montero, José; Cardozo, Celia; Pemán, Javier; Montejo, Miguel; Fortún, Jesús; Almirante, Benito; Castro, C.; Rodríguez-Baño, Jesús CSIC ORCID; Aguado, José María; Martínez, J. A.; Carratalà, Jordi; Soriano, Álex; García‐Vidal, Carolina | Palabras clave: | Antifungals Candidemia De-escalation Invasive candidiasis Outcome |
Fecha de publicación: | jun-2021 | Editor: | Oxford University Press | Citación: | Open Forum Infectious Diseases 8(6): ofab250 (2021) | Resumen: | [Background] 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. [Methods] 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. [Results] 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 > 2 (OR, 4.39; 95% CI, 1.94–9.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14–5.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48–10.61), and prior surgery (OR, 0.29; 95% CI, 0.08–0.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16–1.53). [Conclusions] Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies. |
Versión del editor: | http://dx.doi.org/10.1093/ofid/ofab250 | URI: | http://hdl.handle.net/10261/269481 | DOI: | 10.1093/ofid/ofab250 | Identificadores: | doi: 10.1093/ofid/ofab250 e-issn: 2328-8957 |
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