Impact of select risk factors on treatment outcome in adults with candidemia
Background: Studies examining relationships between patient-related factors and treatment outcome in patients with candidemia are limited and often based on all-cause mortality.
Objective: Our purpose was to examine the impact of concurrent renal replacement therapy (RRT) and other pre-specified factors on treatment outcome among adults with candidemia.
Methods: This Institutional Review Board (IRB)-approved, single-center, case-cohort study included patients over 18 years of age admitted to Duke University Hospital between Jun 1, 2013 and Jun 1, 2017 with a blood culture positive for Candida spp. Treatment-, patient-, and disease-specific data were collected, and outcome (success/failure) determined 90 days after the index culture. An odds ratio (OR) and 95% confidence interval (95%CI) were calculated for the following during therapy: receipt of RRT, fluconazole monotherapy regimen, intensive care unit (ICU) stay, and neutropenia.
Results: Among the 112 encounters (from 110 unique patients) included, treatment failure occurred in 8/112 (7.1%). Demographics were comparable between outcome groups. Among 12 patients receiving concomitant RRT, only 1 patient failed therapy. With regard to treatment failure, no significant differences were observed with RRT (OR, 1.21; 95%CI, 0.14 – 10.75), fluconazole monotherapy regimen (OR, 1.59; 95%CI, 0.3-8.27), ICU stay (OR, 1.43; 95%CI, 0.32-6.29), and neutropenia (0 treatment failures).
Conclusions: Treatment failure, receipt of concomitant RRT, and neutropenia were infrequent in patients undergoing treatment for candidemia. In our cohort, exposure to RRT, a fluconazole monotherapy regimen, ICU stay, or neutropenia during treatment did not impact treatment outcome.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):e1-e50. https://doi.org/10.1093/cid/civ933
Invasive Candidiasis Statistics. https://www.cdc.gov/fungal/diseases/candidiasis/invasive/statistics.html (accessed Jan 19, 2018).
Teo JQ, Candra SR, Lee SJ, Chia SY, Leck H, Tan AL, Neo HP, Leow KW, Cai Y, Ee RP, Lim TP, Kwa AL. Candidemia in a major regional tertiary referral hospital - epidemiology, practice patterns and outcomes. Antimicrob Resist Infect Control. 2017;6:27. https://doi.org/10.1186/s13756-017-0184-1
Grim SA, Berger K, Teng C, Gupta S, Layden JE, Janda WM, Clark NM. Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes. J Antimicrob Chemother. 2012;67(3):707-714. https://doi.org/10.1093/jac/dkr511
Cleveland AA, Harrison LH, Farley MM, Hollick R, Stein B, Chiller TM, Lockhart SR, Park BJ. Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US metropolitan areas, 2008-2013: results from population-based surveillance. PLoS One. 2015;10(3):e0120452. https://doi.org/10.1371/journal.pone.0120452
Cousin L, Berre ML, Launay-vacher V, Izzedine H, Deray G. Dosing guidelines for fluconazole in patients with renal failure. Nephrol Dial Transplant. 2003;18(11):2227-2231. https://doi.org/10.1093/ndt/gfg363
Pfaller M, Neofytos D, Diekema D, Azie N, Meier-Kriesche HU, Quan SP, Horn D. Epidemiology and outcomes of candidemia in 3648 patients: data from the Prospective Antifungal Therapy (PATH Alliance®) registry, 2004-2008. Diagn Microbiol Infect Dis. 2012;74(4):323-331. https://doi.org/10.1016/j.diagmicrobio.2012.10.003
Horn DL, Neofytos D, Anaissie EJ, Fishman JA, Steinbach WJ, Olyaei AJ, Marr KA, Pfaller MA, Chang CH, Webster KM. Epidemiology and outcomes of candidemia in 2019 patients: data from the prospective antifungal therapy alliance registry. Clin Infect Dis. 2009;48(12):1695-1703. https://doi.org/10.1086/599039
Andes DR, Safdar N, Baddley JW, Playford G, Reboli AC, Rex JH, Sobel JD, Pappas PG, Kullberg BJ; Mycoses Study Group. Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: a patient-level quantitative review of randomized trials. Clin Infect Dis. 2012;54(8):1110-1122. https://doi.org/10.1093/cid/cis021
Garnacho-Montero J, Díaz-Martín A, Cantón-Bulnes L, Ramirez P, Sierra R, Asias-Verdu D, Rodriguez-Delgado M, Loza-Vazquez A, Rodriguez-Gomez J, Gordon M, Estella A, Garcia-Garmendia JL. Initial antifungal strategy reduces mortality in critically ill patients with candidemia: a propensity score-adjusted analysis of a multicenter study. Crit Care Med. 2018;46(3):384-393. https://doi.org/10.1097/CCM.0000000000002867
Jones TM, Drew RH, Wilson DT, Sarubbi C, Anderson DJ. Impact of automatic infectious diseases consultation on the management of fungemia at a large academic medical center. Am J Health Syst Pharm. 2017;74(23):1997-2003. https://doi.org/10.2146/ajhp170113
López-Cortés LE, Almirante B, Cuenca-Estrella M, Garnacho-Montero J, Padilla B, Puig-Asensio M, Ruiz-Camps I, Rodriguez-Bano J; members of the CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI. Empirical and targeted therapy of candidemia with fluconazole versus echinocandins: a propensity score-derived analysis of a population-based, multicentre prospective cohort. Clin Microbiol Infect. 2016;22(8):733. https://doi.org/10.1016/j.cmi.2016.05.008
Horn DL, Ostrosky-Zeichner L, Morris MI, Ullmann AJ, Wu C, Buell DN, Kovanda LL, Cornely OA. Factors related to survival and treatment success in invasive candidiasis or candidemia: a pooled analysis of two large, prospective, micafungin trials. Eur J Clin Microbiol Infect Dis. 2010;29(2):223-229. https://doi.org/10.1007/s10096-009-0843-0
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Author Self-Archiving Policy
Pharmacy Practice permits and encourages authors to post and archive the final pdf of the articles submitted to the journal on personal websites or institutional repositories after publication, while providing bibliographic details that credit its publication in this journal.