dc.contributor | Vall d'Hebron Barcelona Hospital Campus |
dc.contributor.author | Moreno-García, E. |
dc.contributor.author | Puerta-Alcalde, P. |
dc.contributor.author | Gariup, G. |
dc.contributor.author | Fernández-Ruiz, M. |
dc.contributor.author | López Cortés, Luis |
dc.contributor.author | Cuervo, G. |
dc.contributor.author | Almirante Gragera, Benito |
dc.date.accessioned | 2022-01-13T13:31:02Z |
dc.date.available | 2022-01-13T13:31:02Z |
dc.date.issued | 2021-06 |
dc.identifier.citation | Moreno-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.issn | 2328-8957 |
dc.identifier.uri | https://hdl.handle.net/11351/6784 |
dc.description | Antifungal; Candidemia; De-escalation |
dc.description.abstract | 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. |
dc.language.iso | eng |
dc.publisher | Oxford University Press |
dc.relation.ispartofseries | Open Forum Infectious Diseases;8(6) |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
dc.source | Scientia |
dc.subject | Medicaments antifúngics - Ús terapèutic |
dc.subject | Micosi - Tractament |
dc.subject | Càndida |
dc.subject.mesh | Candidemia |
dc.subject.mesh | /drug therapy |
dc.subject.mesh | Antifungal Agents |
dc.subject.mesh | /therapeutic use |
dc.title | Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies |
dc.type | info:eu-repo/semantics/article |
dc.identifier.doi | 10.1093/ofid/ofab250 |
dc.subject.decs | candidemia |
dc.subject.decs | /farmacoterapia |
dc.subject.decs | antifúngicos |
dc.subject.decs | /uso terapéutico |
dc.relation.publishversion | https://doi.org/10.1093/ofid/ofab250 |
dc.type.version | info:eu-repo/semantics/publishedVersion |
dc.audience | Professionals |
dc.contributor.organismes | Institut 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.pmid | 34104670 |
dc.identifier.wos | 000715364900045 |
dc.rights.accessrights | info:eu-repo/semantics/openAccess |