Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis.
BACKGROUND
Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes.


METHODS
A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model.


RESULTS
Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure.


CONCLUSIONS
Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.
Department of Infectious Diseases.|Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona.
Guillermo
G
Cuervo
Department of Infectious Diseases.|Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona.
Carolina
C
Garcia-Vidal
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona.
Mireia
M
Puig-Asensio
Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid.
Antonio
A
Vena
Department of Infectious Diseases, Hospital de Barcelona.
Yolanda
Y
Meije
Department of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense de Madrid.
Mario
M
Fernández-Ruiz
Department of Microbiology Hospital Universitari I Politecnic "La Fe,"Valencia, and.
Eva
E
González-Barberá
Department of Infectious Diseases, Hospital Universitario "Cruces,"Bilbao, Spain; and.
María José
MJ
Blanco-Vidal
Department of Infectious Diseases, Hospital "Dr Guillermo Rawson,"San Juan, Argentina.
Adriana
A
Manzur
Department of Infectious Diseases.|Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona.
Celia
C
Cardozo
Department of Infectious Diseases.|Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona.
Carlota
C
Gudiol
Department of Infectious Diseases, Hospital Universitario "Cruces,"Bilbao, Spain; and.
José Miguel
JM
Montejo
Department of Microbiology Hospital Universitari I Politecnic "La Fe,"Valencia, and.
Javier
J
Pemán
Department of Infectious Diseases.|Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona.
Josefina
J
Ayats
Department of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense de Madrid.
Jose María
JM
Aguado
Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid.
Patricia
P
Muñoz
Department of Infectious Diseases.|Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona.
Francesc
F
Marco
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona.
Benito
B
Almirante
Department of Infectious Diseases.|Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona.
Jordi
J
Carratalà
D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification; D041221:Candida glabrata / Q000187:drug effects / Q000302:isolation & purification; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D054714:Echinocandins / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D051437:Renal Insufficiency / Q000382:microbiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology
D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole
candidemia; echinocandin therapy; propensity score.; urinary source