Candida spp. bloodstream infection: influence of antifungal treatment on outcome.
OBJECTIVE
To assess the influence of new antifungal treatments on candidaemia outcome.


METHODS
Candidaemia episodes prospectively collected through a blood culture surveillance programme in a single institution. The study was divided into two periods of time, 1994-2003 (A) and 2004-2008 (B), according to the introduction of echinocandin treatment. Non-conditional logistic regression methods with mortality as the dependent variable were used.


RESULTS
Four hundred and thirty-three (3%) candidaemias out of 15 628 bloodstream infection episodes were analysed. Candida albicans was the most frequent species (211; 49%). Mortality was noted in 132 cases (30%). A total of 262 and 171 candidaemias were reported in period A and B, respectively. There were 94 deaths in period A (36%) and 38 in period B (22%, P = 0.03). Treatment in period A was amphotericin B in 89 patients (41 dead, 46%) and fluconazole in 151 (41 dead, 27%, P = 0.003). In period B, 113 patients received a triazole (26 dead, 23%), 30 an echinocandin (3 dead, 10%, P = 0.08) and 9 (0 dead) were treated with combined therapy (echinocandin and triazole). Mortality was higher in period A (94 dead, 36%) than in period B (38 dead, 27%), P = 0.03. Independent risk factors associated with mortality in period B were: age, chronic renal failure, ultimately or rapidly fatal prognosis of underlying disease and shock. Echinocandin alone or in combination therapy was associated with better outcome (odds ratio = 0.22, 95% confidence interval = 0.06-0.81, P = 0.02).


CONCLUSIONS
In patients with candidaemia, echinocandin therapy results in a better outcome.
Ortega
M
M
Emergency Department and Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain. mortega@clinic.ub.es
Marco
F
F
Soriano
A
A
Almela
M
M
Martínez
J A
JA
Pitart
C
C
Mensa
J
J
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
D000935:Antifungal Agents; D054714:Echinocandins; D014230:Triazoles