title: Fluconazole versus an echinocandin for Candida glabrata fungaemia: a retrospective cohort study.
abstract: OBJECTIVE
  We studied whether fluconazole or echinocandin treatment of Candida glabrata fungaemia results in superior outcomes.
  
  
  METHODS
  A multicentre, retrospective study was performed with 224 adult patients who received ≥ 5 days of therapy with either fluconazole or an echinocandin as their first antifungal treatment after collection of a blood culture that grew C. glabrata. The primary outcome was day 14 complete response.
  
  
  RESULTS
  Patients in the echinocandin group were generally more ill, both at baseline and at the time of the index culture. Day 14 complete response was obtained in 58/127 (46%) and 50/97 (52%) of the fluconazole and echinocandin patients, respectively (P=0.383). Logistic regression found intensive care unit admission to be associated with failure [OR 0.456 (0.217-0.957), P=0.038] and echinocandin therapy to be associated with day 14 complete response [OR 2.305 (1.124-4.727), P=0.023]. Twenty-eight day survival was similar between the fluconazole and echinocandin groups and logistic regression did not reveal antifungal therapy choice to be independently predictive of mortality. For patients treated with fluconazole, a dose:MIC ratio >12.5 (when compared with a ratio ≤ 12.5) was associated with a significantly higher day 14 complete response [4/20 (20%) ≤ 12.5 versus 50/102 (49%) >12.5, P=0.025].
  
  
  CONCLUSIONS
  Severity of illness and choice of antifungal predict response in patients with C. glabrata fungaemia. Antifungal choice, however, does not influence mortality. In addition, new CLSI C. glabrata fluconazole susceptibility breakpoints are predictive of response when fluconazole is dosed appropriately.
authors.affiliation: Department of Pharmacy, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. eschenauerg@upmc.edu
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Eschenauer
authors.forename: Peggy L
authors.initials: PL
authors.lastname: Carver
authors.forename: Shu-Wen
authors.initials: SW
authors.lastname: Lin
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Klinker
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Brian A
authors.initials: BA
authors.lastname: Potoski
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Shields
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Clancy
authors.forename: Minh-Hong
authors.initials: MH
authors.lastname: Nguyen
authors.forename: Simon W
authors.initials: SW
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D041221:Candida glabrata / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole