title: A multicentre study to evaluate the impact of timing of caspofungin administration on outcomes of invasive candidiasis in non-immunocompromised adult patients.
abstract: OBJECTIVE
  Candida non-albicans species cause an increasing proportion of invasive candidiasis (IC). Prompt initiation of effective antifungal therapy has been shown to positively impact the outcomes of IC. Caspofungin is often reserved as a second-line agent after suboptimal response to initial therapy. We determined the impact of the timing of caspofungin administration on outcomes of IC.
  
  
  METHODS
  Medical records were reviewed on all hospitalized adults who received >or=72 h of caspofungin for IC (isolation of Candida species from blood, intra-abdominal or other sterile sites). Clinical data were extracted from medical charts and recorded. Patients were classified based on delayed initiation (DI; >3 days) versus early initiation (EI; <or=3 days) of caspofungin relative to the time the culture was obtained.
  
  
  RESULTS
  A total of 169 patients received caspofungin for IC; Candida glabrata (n = 78, 46%) was the most common cause, followed by mixed species (n = 36, 21%), Candida albicans (n = 36, 21%), Candida parapsilosis (n = 9, 6%), Candida tropicalis (n = 6, 3%), Candida krusei and other species (n = 4, 2%). Infection sites were bloodstream related (n = 119, 71%), intra-abdominal (n = 44, 26%) and other sterile sites (n = 6, 3%). DI of caspofungin was associated with a lower response rate (35/62, 56% versus 82/107, 77%; P = 0.006), longer time to achieve clinical stability (10 versus 4 days; P = 0.002) and longer length of stay after isolation of the organism (28 versus 21 days; P = 0.007), compared with EI (n = 107).
  
  
  CONCLUSIONS
  Non-albicans Candida species accounted for the majority of IC in caspofungin-treated patients. Improved outcomes were observed for patients initiated with caspofungin within 72 h of positive culture compared with those who received delayed therapy.
authors.affiliation: Western University College of Pharmacy, 309 E. Second Street, Pomona, CA 91766, USA. dhsu@westernu.edu
authors.forename: Donald I
authors.initials: DI
authors.lastname: Hsu
authors.forename: Megan
authors.initials: M
authors.lastname: Nguyen
authors.forename: Lee
authors.initials: L
authors.lastname: Nguyen
authors.forename: Anandi
authors.initials: A
authors.lastname: Law
authors.forename: Annie
authors.initials: A
authors.lastname: Wong-Beringer
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D015331:Cohort Studies; D054714:Echinocandins / Q000008:administration & dosage*; D006801:Humans; D055666:Lipopeptides; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin