RT Journal Article
T1 Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies
A1 Moreno-Garcia, E.
A1 Puerta-Alcalde, P.
A1 Gariup, G.
A1 Fernandez-Ruiz, M.
A1 Lopez Cortes, L. E.
A1 Cuervo, G.
A1 Salavert, M.
A1 Merino, P.
A1 Machado, M.
A1 Guinea, J.
A1 Garcia-Rodriguez, J.
A1 Garnacho-Montero, J.
A1 Cardozo, C.
A1 Peman, J.
A1 Montejo, M.
A1 Fortun, J.
A1 Almirante, B.
A1 Castro, C.
A1 Rodriguez-Bano, J.
A1 Aguado, J. M.
A1 Martinez, J. A.
A1 Carratala, J.
A1 Soriano, A.
A1 Garcia-Vidal, C.
A1 Project GEMICOMED SEIMC, 
K1 antifungal
K1 candidemia
K1 de-escalation
K1 invasive candidiasis
K1 outcome
K1 Critically-ill patients
K1 De-escalation
K1 Down therapy
K1 Antifungal
K1 Susceptibility
K1 Candidaemia
K1 Management
K1 Guideline
K1 Mortality
AB Background. There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection.Methods. This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (20072016). The impact of ED and factors associated with mortality were assessed.Results. Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P = .006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P = .043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P = .016), and candidemia from an unknown source (24.1% vs 47%; P = .003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P = .006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48-10.61), Pitt score > 2 (OR, 4.39; 95% CI, 1.94-9.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14-5.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48-10.61), and prior surgery (OR, 0.29; 95% CI, 0.08-0.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16-1.53).Conclusions. Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies.
PB Oxford univ press inc
SN 2328-8957
YR 2021
FD 2021-05-16
LK https://hdl.handle.net/10668/27322
UL https://hdl.handle.net/10668/27322
LA en
DS RISalud
RD Apr 12, 2025