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dc.contributorVall d'Hebron Barcelona Hospital Campus
dc.contributor.authorMoreno-García, E.
dc.contributor.authorPuerta-Alcalde, P.
dc.contributor.authorGariup, G.
dc.contributor.authorFernández-Ruiz, M.
dc.contributor.authorLópez Cortés, Luis
dc.contributor.authorCuervo, G.
dc.contributor.authorAlmirante Gragera, Benito
dc.date.accessioned2022-01-13T13:31:02Z
dc.date.available2022-01-13T13:31:02Z
dc.date.issued2021-06
dc.identifier.citationMoreno-García E, Puerta-Alcalde P, Gariup G, Fernández-Ruiz M, López Cortés LE, Cuervo G, et al. Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies. Open Forum Infect Dis. 2021 Jun;8(6):ofab250.
dc.identifier.issn2328-8957
dc.identifier.urihttp://hdl.handle.net/11351/6784
dc.descriptionAntifungal; Candidemia; De-escalation
dc.description.abstractBackground 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.
dc.language.isoeng
dc.publisherOxford University Press
dc.relation.ispartofseriesOpen Forum Infectious Diseases;8(6)
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.sourceScientia
dc.subjectMedicaments antifúngics - Ús terapèutic
dc.subjectMicosi - Tractament
dc.subjectCàndida
dc.subject.meshCandidemia
dc.subject.mesh/drug therapy
dc.subject.meshAntifungal Agents
dc.subject.mesh/therapeutic use
dc.titleEarly Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies
dc.typeinfo:eu-repo/semantics/article
dc.identifier.doi10.1093/ofid/ofab250
dc.subject.decscandidemia
dc.subject.decs/farmacoterapia
dc.subject.decsantifúngicos
dc.subject.decs/uso terapéutico
dc.relation.publishversionhttps://doi.org/10.1093/ofid/ofab250
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dc.audienceProfessionals
dc.contributor.organismesInstitut Català de la Salut
dc.contributor.authoraffiliation[Moreno-García E, Puerta-Alcalde P, Gariup G] Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. [Fernández-Ruiz M] Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas+12), Universidad Complutense, Madrid, Spain. [López Cortés LE] Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, CSIC, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain. [Cuervo G] Hospital Universitari de Bellvitge, IDIBELL (Institut d’Investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain. [Almirante B] Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain
dc.identifier.pmid34104670
dc.identifier.wos000715364900045
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess


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