Predictors of choice of initial antifungal treatment in intraabdominal candidiasis

Predictors of choice of initial antifungal treatment in intraabdominal candidiasis

Author Lagunes, L. Google Scholar
Borgatta, B. Google Scholar
Martin-Gomez, M. T. Google Scholar
Rey-Perez, A. Google Scholar
Antonelli, M. Google Scholar
Righi, E. Google Scholar
Merelli, M. Google Scholar
Brugnaro, P. Google Scholar
Dimopoulos, G. Google Scholar
Garnacho-Montero, J. Google Scholar
Colombo, A. L. Autor UNIFESP Google Scholar
Luzzati, R. Google Scholar
Menichetti, F. Google Scholar
Munoz, P. Google Scholar
Nucci, M. Google Scholar
Scotton, G. Google Scholar
Viscoli, C. Google Scholar
Tumbarello, M. Google Scholar
Bassetti, M. Google Scholar
Rello, J. Google Scholar
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

323%). 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. L. Lagunes, (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Keywords Adequate treatment
Antifungal therapy
Candida
Guidelines
Intraabdominal candidiasis
Invasive fungal disease
Septic shock
xmlui.dri2xhtml.METS-1.0.item-coverage Oxford
Language English
Sponsor Pfizer Inc.
Merck Serono
Gilead Sciences
Teva Inc.
Astellas Pharma Inc.
United Medical
MSD
Pfizer
Novartis
AstraZeneca
Zambon
Astellas
Date 2016
Published in Clinical Microbiology And Infection. Oxford, v. 22, n. 8, p. 719-724, 2016.
ISSN 1198-743X (Sherpa/Romeo, impact factor)
Publisher Elsevier Sci Ltd
Extent 719-724
Origin http://dx.doi.org/10.1016/j.cmi.2016.06.005
Access rights Closed access
Type Article
Web of Science ID WOS:000383824200014
URI https://repositorio.unifesp.br/handle/11600/57437

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