title: Initial antifungal strategy does not correlate with mortality in patients with candidemia.
abstract: The incidence of Candida bloodstream infections (BSIs) has increased over time, especially in medical wards. The objective of this study was to evaluate the impact of different antifungal treatment strategies on 30-day mortality in patients with Candida BSI not admitted to intensive care units (ICUs) at disease onset. This prospective, monocentric, cohort study was conducted at an 1100-bed university hospital in Rome, Italy, where an infectious disease consultation team was implemented. All cases of Candida BSIs observed in adult patients from November 2012 to April 2014 were included. Patients were grouped according to the initial antifungal strategy: fluconazole, echinocandin, or liposomal amphotericin B. Cox regression analysis was used to identify risk factors significantly associated with 15-day and 30-day mortality. During the study period, 130 patients with candidemia were observed (58 % with C. albicans, 7 % with C. glabrata, and 23 % with C. parapsilosis). The first antifungal drug was fluconazole for 40 % of patients, echinocandin for 57.0 %, and liposomal amphotericin B for 4 %. During follow-up, 33 % of patients died. The cumulative mortality 30 days after the candidemia episode was 30.8 % and was similar among groups. In the Cox regression analysis, clinical presentation was the only independent factor associated with 15-day mortality, and Acute Physiology and Chronic Health Evaluation (APACHE) II score and clinical presentation were the independent factors associated with 30-day mortality. No differences in 15-day and 30-day mortality were observed between patients with and without C. albicans candidemia. In patients with candidemia admitted to medical or surgical wards, clinical severity but not the initial antifungal strategy were significantly correlated with mortality.
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy. ritamurri@rm.unicatt.it.
authors.forename: R
authors.initials: R
authors.lastname: Murri
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scoppettuolo
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ventura
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fabbiani
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Giovannenze
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Taccari
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Milozzi
authors.affiliation: Institute of Public Health, Section of Hygiene, Catholic University of Rome, Rome, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Posteraro
authors.affiliation: Institute of Microbiology, Catholic University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sanguinetti
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cauda
authors.affiliation: Institute of Infectious Diseases, Catholic University of Rome, L.go A. Gemelli, 8, 00168, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fantoni
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000302:isolation & purification; 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*; D005656:Fungal Proteins / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; C068538:liposomal amphotericin B; D000666:Amphotericin B; D015725:Fluconazole; C007572:echinocandin B