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Rev Esp Quimioter 2018; November 30

Impact of empirical treatment with antifungal agents on survival of patients with candidemia

RODRIGO POVES-ALVAREZ, BEATRIZ CANO-HERNÁNDEZ, MARÍA FE MUÑOZ-MORENO, SARA BALBÁS-ALVAREZ, PATRICIA ROMÁN-GARCÍA, ESTHER GÓMEZ-SÁNCHEZ, BEATRIZ MARTÍNEZ-RAFAEL, ESTEFANÍA GÓMEZ-PESQUERA, MARIO LORENZO-LÓPEZ, ELISA ALVAREZ-FUENTE, OLGA DE LA VARGA, MIGUEL FLORES, JOSÉ MARÍA EIROS, EDUARDOTAMAYO, MARÍA HEREDIA-RODRÍGUEZ

Introduction. The objective of this study was to evaluate the impact of echinocandins and fluconazole) on mortality 7 and 30 days after candidemia onset and overall in-hospital mortality), in patients with candidemia at a Spanish tertiary hospital.
Methods. A retrospective study was conducted that enrolled all non-neutropenic adult patients diagnosed with candidemia at Hospital Clínico Universitario de Valladolid between 2007 and 2016. A total of 179 patients were evaluated, they were divided into two sub-groups: surviving patients (n = 92) and non-surviving patients (n = 87).
Results. The 7-day mortality was 25,1% (45), 30-day mortality was 46,9% (84), and overall in-hospital mortality was 48,6% (87). 40.8% of patients received no antifungal treatment (43.8% of surviving patients and 37.8% of non-surviving patients; p=0.15). A total of 106 (59.2%) patients were treated, of which 90 patients (50.3%) received empiric treatment. 19.6% and 47.8% of surviving patients were treated with echinocandins and fluconazole, respectively. By contrast, of non-surviving patients, 31.0% were treated with echinocandins and 47.1% received fluconazole. Survival for the first 7 days was significantly higher in treated with antifungal agents (log-rank = 0.029), however, there were not significant differences in 30-day survival. Factors linked to a significant increase in overall in-hospital mortality were age (OR 1.040), septic shock (OR 2.694) and need for mechanical ventilation > 48 h (OR 2.812).
Conclusion. Patients who received antifungal treatment, regardless of whether they received fluconazole or echinocandins, had a significantly lower mortality rate after 7 days than untreated patients, although no significant differences in 30-day mortality were seen.

Rev Esp Quimioter 2018; November 30  [Full-text PDF]