title: Outcomes with micafungin in patients with candidaemia or invasive candidiasis due to Candida glabrata and Candida krusei.
abstract: OBJECTIVE
  Infection with Candida glabrata and Candida krusei represents a major challenge. We sought to describe outcomes for patients with candidaemia/invasive candidiasis (C/IC) due to these pathogens who were treated with micafungin.
  
  
  METHODS
  We pooled two randomized trials of micafungin versus comparator. We identified patients infected with either C. glabrata or C. krusei. One trial compared micafungin (100 mg/day with option for dose escalation) with liposomal amphotericin B, while the other compared micafungin (either 100 or 150 mg/day) and caspofungin (NCT00106288 and NCT00105144). Clinical cure was our primary endpoint while 28 day mortality represented a secondary endpoint.
  
  
  RESULTS
  Among 1070 subjects with C/IC, 183 were infected with either C. glabrata (n = 144) or C. krusei (n = 39). One hundred and seventeen received micafungin. Clinical cure rates in those receiving micafungin were similar to those randomized to comparator [73.5% (86/117) versus 62.1% (41/66), P = not significant]. Mortality at 28 days was also similar [29.1% (34/117) with micafungin versus 34.8% (23/66) with comparator, P = not significant]. In logistic regression, treatment agent correlated with neither cure nor mortality. Factors independently linked with lower cure rates included: IC neutropenia; higher severity of illness; and medical admission. Higher severity of illness and failure to remove a central venous catheter were associated with 28 day mortality. Crude and adjusted outcomes were comparable irrespective of micafungin dose administered.
  
  
  CONCLUSIONS
  Micafungin results in similar outcomes to comparators for C/IC due to C. glabrata and C. krusei. The 100 mg/day dose represents an acceptable option in this setting. Patient characteristics and catheter management appear to be more important factors affecting clinical outcomes.
authors.affiliation: Pulmonary and Critical Care, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA. afshorr@dnamail.com
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
authors.forename: Chunzhang
authors.initials: C
authors.lastname: Wu
authors.forename: Smita
authors.initials: S
authors.lastname: Kothari
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects*; D041221:Candida glabrata / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin; D000077551:Micafungin