title: Comparative effectiveness of echinocandins versus fluconazole therapy for the treatment of adult candidaemia due to Candida parapsilosis: a retrospective observational cohort study of the Mycoses Study Group (MSG-12).
abstract: A polymorphism in the gene encoding β-1,3-glucan synthase, the target of the echinocandin class of antifungals, results in increased in vitro MICs of the echinocandins. This has resulted in controversy surrounding use of the echinocandins for treatment of Candida parapsilosis candidaemia. We aimed to compare 30 day mortality in adults with C. parapsilosis candidaemia treated with echinocandins versus fluconazole.
  
  
  
  This is a retrospective observational cohort study. We used the Premier Perspective Database to identify adult patients with C. parapsilosis candidaemia treated with only fluconazole or only an echinocandin as definitive therapy. The primary outcome was 30 day mortality. Propensity scores were derived to estimate the probability the patient would have received either an echinocandin or fluconazole. Inverse probability of treatment weighting (IPTW) was used in a weighted logistic regression to calculate odds of 30 day mortality.
  
  
  
  There were 307 unique patients with C. parapsilosis candidaemia. One hundred and twenty-six (41%) received fluconazole and 181 (59%) received an echinocandin. Age, gender, race, year of admission, need for ICU resources in the week prior to candidaemia onset, and receipt of vasopressors on the day of candidaemia onset were included in the propensity score model used to calculate inverse probability of treatment weights. Weighted logistic regression demonstrated no difference in 30 day mortality between patients receiving an echinocandin as compared with fluconazole (OR 0.82, 95% CI 0.33-2.07).
  
  
  
  Our result supports the 2016 IDSA invasive candidiasis guidelines, which no longer clearly favour treatment with fluconazole over an echinocandin for C. parapsilosis candidaemia.
authors: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA chiotosk@email.chop.edu.|Division of Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Kathleen
authors: K
authors: Chiotos
authors: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors: Neika
authors: N
authors: Vendetti
authors: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Pediatric 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: Theoklis E
authors: TE
authors: Zaoutis
authors: Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA.|Medical Service, Birmingham Veterans' Affairs Medical Center, Birmingham, AL, USA.
authors: John
authors: J
authors: Baddley
authors: Division of Infectious Diseases, University of Texas Medical School, Houston, TX, USA.
authors: Luis
authors: L
authors: Ostrosky-Zeichner
authors: Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA.
authors: Peter
authors: P
authors: Pappas
authors: Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Center for Pediatric 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: Brian T
authors: BT
authors: Fisher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality*; D054714:Echinocandins / Q000627:therapeutic use*; D015725:Fluconazole / Q000627:therapeutic use*; D005964:Glucosyltransferases / Q000037:antagonists & inhibitors; D006801:Humans; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole; D005964:Glucosyltransferases