title: Comparative effectiveness of fungicidal vs. fungistatic therapies for the treatment of paediatric candidaemia.
abstract: Adult data suggest that echinocandins for treatment of candidaemia are associated with decreased mortality, attributed to their fungicidal activity. There are limited data comparing antifungals in children. We compared 30-day all-cause mortality among paediatric candidaemia patients treated with fungicidal vs. fungistatic agents. All inpatients (>6 months and <19 years of age) with candidaemia between 2000 and 2012 at The Children's Hospital of Philadelphia were retrospectively identified. Definitive therapy with fungicidal (amphotericin B and caspofungin) agents was compared with fungistatic (fluconazole) agents. A propensity score model generated the inverse probability of receiving a fungicidal agent, which was included in a weighted logistic regression model. Among 203 children meeting inclusion criteria, 151 (74.4%) and 52 (25.6%) received a fungicidal and fungistatic agent, respectively. Overall, 18 (8.9%) patients died within 30 days. There was no statistically significant difference in mortality between patients started on a fungicidal or fungistatic agent (OR: 2.19, 95% CI: 0.42-11.48). In a propensity score-weighted model, definitive therapy with a fungicidal agent did not result in a significant decrease in mortality. These data suggest that both agents can be considered definitive therapy for paediatric candidaemia. The results should be interpreted with caution given the small sample size. Larger cohort studies are needed.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Paediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Neika
authors.initials: N
authors.lastname: Vendetti
authors.affiliation: Center for Paediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Department of Paediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bryan
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Paediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Andreas
authors.initials: A
authors.lastname: Damianos
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Paediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Fisher
mesh_terms: D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D058387:Candidemia / Q000188:drug therapy*; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D054714:Echinocandins / Q000627:therapeutic use*; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007297:Inpatients; D055666:Lipopeptides / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000666:Amphotericin B; D015725:Fluconazole; D000077336:Caspofungin
keywords: Candidaemia; antifungals; comparative effectiveness; paediatric