title: Initial use of echinocandins does not negatively influence outcome in Candida parapsilosis bloodstream infection: a propensity score analysis.
abstract: BACKGROUND
  Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins.
  
  
  METHODS
  The Prospective Population Study on Candidemia in Spain (CANDIPOP) is a prospective multicenter, population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing, and antifungal susceptibility testing was performed by the European Committee on Antimicrobial Susceptibility Testing methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analyzed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach.
  
  
  RESULTS
  Among 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58 of 177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio [AOR], 2.81; P = .018) and septic shock (AOR, 2.91; P = .081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (AOR, 0.43; P = .040). Neither univariate nor multivariate analysis revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding.
  
  
  CONCLUSIONS
  The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre," Madrid.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.forename: José María
authors.initials: JM
authors.lastname: Aguado
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.forename: David
authors.initials: D
authors.lastname: Lora-Pablos
authors.forename: Belén
authors.initials: B
authors.lastname: Padilla
authors.forename: Mireia
authors.initials: M
authors.lastname: Puig-Asensio
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo
authors.forename: Julio
authors.initials: J
authors.lastname: García-Rodríguez
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
authors.forename: Maite
authors.initials: M
authors.lastname: Ruiz Pérez de Pipaón
authors.forename: Manuel
authors.initials: M
authors.lastname: Cuenca-Estrella
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011159:Population Surveillance; D057216:Propensity Score; D011446:Prospective Studies; D012307:Risk Factors; D017422:Sequence Analysis, DNA; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins
keywords: Candida parapsilosis; bloodstream infection; echinocandin; propensity score; treatment