title: Therapeutic approaches in patients with candidemia. Evaluation in a multicenter, prospective, observational study.
abstract: OBJECTIVE
  To evaluate the morbidity and mortality of Candida fungemia and to assess the efficacy of low- vs high-dose amphotericin B and fluconazole vs amphotericin B in patients with candidemia.
  
  
  METHODS
  Multicenter, prospective, observational study of 427 consecutive patients with candidemia.
  
  
  RESULTS
  The mortality rate for patients with candidemia was 34%. The mortality rate for patients with catheter-related candidemia in whom the catheters were retained was significantly higher than that of patients in whom the catheters were removed (41% vs 21%, P < .001). We found no overall difference in mortality in patients treated with low-dose (total amphotericin B dose of < or = 500 mg) (13%) vs high-dose amphotericin B (total amphotericin B dose of > 500 mg) (15%), but the group treated with a low dose had fewer side effects (40%) than those treated with a high dose (55%) (P = .03). Fluconazole was as efficacious as amphotericin B in the therapy of candidemia, even when stratified by risk factors for mortality. Fewer side effects were seen with fluconazole (12%) compared with amphotericin B (44%) (P < .001).
  
  
  CONCLUSIONS
  In selected patients with candidemia, low-dose amphotericin B was as efficacious as high-dose amphotericin B. Based on other studies and ours, fluconazole seems to be an alternative therapeutic option to amphotericin B in selected patients.
authors.affiliation: Department of Medicine, University of Pittsburgh, PA, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Nguyen
authors.forename: J E
authors.initials: JE
authors.lastname: Peacock
authors.forename: D C
authors.initials: DC
authors.lastname: Tanner
authors.forename: A J
authors.initials: AJ
authors.lastname: Morris
authors.forename: M L
authors.initials: ML
authors.lastname: Nguyen
authors.forename: D R
authors.initials: DR
authors.lastname: Snydman
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: V L
authors.initials: VL
authors.lastname: Yu
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D002408:Catheters, Indwelling / Q000009:adverse effects; D015725:Fluconazole / Q000627:therapeutic use*; D016469:Fungemia / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole