title: Predictors of choice of initial antifungal treatment in intraabdominal candidiasis.
abstract: Intraabdominal candidiasis (IAC) is the second most frequent form of invasive candidiasis, and is associated with high mortality rates. This study aims to identify current practices in initial antifungal treatment (IAT) in a real-world scenario and to define the predictors of the choice of echinocandins or azoles in IAC episodes. Secondary analysis was performed of a multinational retrospective cohort at 13 teaching hospitals in four countries (Italy, Greece, Spain and Brazil), over a 3-year period (2011-2013). IAC was identified in 481 patients, 323 of whom received antifungal therapy (classified as the treatment group). After excluding 13 patients given amphotericin B, the treatment group was further divided into the echinocandin group (209 patients; 64.7%) and the azole group (101 patients; 32.3%). Median APACHE II scores were significantly higher in the echinocandin group (p 0.013), but IAT did not differ significantly with regard to the Candida species involved. Logistic multivariate stepwise regression analysis, adjusted for centre effect, identified septic shock (adjusted OR (aOR) 1.54), APACHE II >15 (aOR 1.16) and presence in surgical ward at diagnosis (aOR 1.16) as the top three independent variables associated with an empirical echinocandin regimen. No differences in 30-day mortality were observed between groups. Echinocandin regimen was the first choice for IAT in patients with IAC. No statistical differences in mortality were observed between regimens, but echinocandins were administered to patients with more severe disease. Some disagreements were identified between current clinical guidelines and prescription of antifungals for IAC at the bedside, so further educational measures are required to optimize therapies.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain; Medicine Department, Universitat Autónoma de Barcelona, Spain. Electronic address: leonel.lagunes@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Lagunes
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Borgatta
authors.affiliation: Microbiology Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: M T
authors.initials: MT
authors.lastname: Martín-Gomez
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rey-Pérez
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: IAC Study Coordinator, Santa Maria Misericordia University Hospital, Infectious Diseases Division, Udine, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Righi
authors.affiliation: IAC Study Coordinator, Santa Maria Misericordia University Hospital, Infectious Diseases Division, Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Merelli
authors.affiliation: Venezia Hospital, Infectious Diseases Division, Venice, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Brugnaro
authors.affiliation: Attikon University Hospital, Critical Care Department, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, Seville, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Garnacho-Montero
authors.affiliation: Escola Paulista de Medicina UNIFESP, Sao Paulo, Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Colombo
authors.affiliation: University Hospital of Trieste, Trieste, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Luzzati
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Menichetti
authors.affiliation: CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.affiliation: University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Nucci
authors.affiliation: Treviso Hospital, Treviso, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Scotton
authors.affiliation: Azienda Ospedaliera Universitaria, Genoa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Viscoli
authors.affiliation: Sacro Cuore Catholic University Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: IAC Study Coordinator, Santa Maria Misericordia University Hospital, Infectious Diseases Division, Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Medicine Department, Universitat Autónoma de Barcelona, Spain; University Hospital of Trieste, Trieste, Italy.
authors.forename: J
authors.initials: J
authors.lastname: Rello
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D000066491:Clinical Decision-Making; D032921:Consensus; D019468:Disease Management; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents
keywords: Adequate treatment; Antifungal therapy; Candida; Guidelines; Intraabdominal candidiasis; Invasive fungal disease; Septic shock