The impact of delaying the initiation of appropriate antifungal treatment for Candida bloodstream infection.
We performed a retrospective analysis of the time to initiation of appropriate antifungal therapy for candidemia and in-hospital mortality. The definition of appropriate antifungal therapy was based on in vitro susceptibility results, and in the case of fluconazole, pharmacodynamic parameters. Of 123 patients, the mortality rate in the <24 h, 24-48 h, and >48 h groups was 50%, 28%, and 32%, respectively. Patients who never received antifungal treatment had a 61% mortality rate (difference between groups, P =0.06). Multivariate analysis found APACHE II score (AOR = 1.09, 95% CI: 1.02-1.17 for each point increase) to be the only independent predictor of mortality. The time to initiation of appropriate antifungal therapy did not correlate with in-hospital mortality.
Kludze-Forson
Maabo
M
Saint Vincent's Hospital, Department of Pharmacy, Manhattan, New York, NY, USA.
Eschenauer
Gregory A
GA
Kubin
Christine J
CJ
Della-Latta
Phyllis
P
Lam
Simon W
SW
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000935:Antifungal Agents / Q000008:administration & dosage*; D002175:Candida; D002177:Candidiasis / Q000188:drug therapy*; D000077336:Caspofungin; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000008:administration & dosage; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage; D016469:Fungemia / Q000188:drug therapy*; D006801:Humans; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D015725:Fluconazole; D000077336:Caspofungin