RT Journal Article
T1 Empirical and targeted therapy of candidemia with fluconazole versus echinocandins: a propensity score-derived analysis of a population-based, multicentre prospective cohort
A1 Lopez-Cortes, L. E.
A1 Almirante, B.
A1 Cuenca-Estrella, M.
A1 Garnacho-Montero, J.
A1 Padilla, B.
A1 Puig-Asensio, M.
A1 Ruiz-Camps, I.
A1 Rodriguez-Bano, J.
A1 CANDIPOP Project GEIH-GEMICOMED, 
K1 Bloodstream infection
K1 Candidemia
K1 Echinocandins
K1 Empirical therapy
K1 Targeted therapy
K1 Blood-stream infections
K1 Invasive candidiasis
K1 Antifungal treatment
K1 Anidulafungin
K1 Resistance
K1 Outcomes
K1 Impact
K1 Identification
K1 Epidemiology
K1 Surveillance
AB We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17e0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41-1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia. L.E. Lopez-Cortes, (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
PB Elsevier sci ltd
SN 1198-743X
YR 2016
FD 2016-08-01
LK http://hdl.handle.net/10668/18750
UL http://hdl.handle.net/10668/18750
LA en
DS RISalud
RD Apr 6, 2025