Attributable mortality of candidemia after introduction of echinocandins.
Aged
Amphotericin B
/ therapeutic use
Antifungal Agents
/ therapeutic use
Candida
/ drug effects
Candidemia
/ drug therapy
Case-Control Studies
Cross Infection
/ drug therapy
Echinocandins
/ therapeutic use
Female
Germany
Hospital Mortality
Hospitalization
Hospitals, University
/ statistics & numerical data
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Risk Factors
Candida Registry
EQUAL Candida score
antifungal treatment
attributable mortality
candidemia
echinocandin
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
22
08
2020
accepted:
26
08
2020
pubmed:
5
9
2020
medline:
13
7
2021
entrez:
5
9
2020
Statut:
ppublish
Résumé
Candidemia is among the most frequent nosocomial bloodstream infections. Landmark case-control studies on amphotericin B and fluconazole estimated attributable mortality rates of 38% and 49%, respectively. After introduction of echinocandins, these may have decreased. In a case-control design, 100 consecutive, hospitalised patients with candidemia were enrolled at the University Hospital of Cologne, Germany between 2014 and 2017. Controls were patients without candidemia matched for age, sex, year and duration of hospitalisation, main admission diagnosis and Patient Clinical Complexity Level (PCCL). Main data captured were risk factors for candidemia, attributable mortality rates and diagnostic and therapeutic adherence according to the EQUAL Candida score. Overall mortality rates for cases and controls were 43% and 17% (P < .001), respectively; day 30 mortality rates were 38% and 11% (P = .03), accounting for an attributable mortality of 26% and 27%. Guideline adherence was higher in surviving vs non-surviving patients: while survivors reached a median of 17 (IQR: 16-19) points, non-surviving cases reached a median 16 (IQR: 14-18) points out of 22 maximum achievable points (P = .028). Risk factors for candidemia were more frequent in cases compared to control patients, especially chronic pulmonary disease (25% vs 16%; P = n.s.), chronic liver disease (21% vs 6%; P = .002), stay on intensive care unit (70% vs 64%; P = n.s.), respiratory failure (56% vs 50%; P = n.s.) and central venous catheter (97% vs 35%; P < .001). Attributable mortality of nosocomial candidemia is still substantial but has decreased compared to previous studies with similar design.
Substances chimiques
Antifungal Agents
0
Echinocandins
0
Amphotericin B
7XU7A7DROE
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1373-1381Informations de copyright
© 2020 Wiley-VCH GmbH.
Références
Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39(3):S309-S317.
Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014;10:95-105.
Cornely OA, Gachot B, Akan H, et al. Epidemiology and outcome of fungemia in a cancer Cohort of the Infectious Diseases Group (IDG) of the European Organization for Research and Treatment of Cancer (EORTC 65031). Clin Infect Dis. 2015;61(3):S324-S331.
Gudlaugsson O, Gillespie S, Lee K, et al. Attributable mortality of nosocomial candidemia, revisited. Clin Infect Dis. 2003;37(9):S1172-S1177.
Koehler P, Stecher M, Cornely OA, et al. Morbidity and mortality of candidaemia in Europe: an epidemiologic meta-analysis. Clin Microbiol Infect. 2019;10:1200-1212.
Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Risk factors for hospital-acquired candidemia. A matched case-control study. Arch Intern Med. 1989;149(10):S2349-S2353.
Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med. 1988;148(12):S2642-S2645.
Klein JJ, Watanakunakorn C. Hospital-acquired fungemia. Its natural course and clinical significance. Am J Med. 1979;67(1):S51-S58.
Horn R, Wong B, Kiehn TE, Armstrong D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Rev Infect Dis. 1985;7(5):S646-S655.
Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. Candidemia Study Group and the National Institute. N Engl J Med. 1994;331(20):S1325-S1330.
Rex JH, Walsh TJ, Sobel JD, et al. Practice guidelines for the treatment of candidiasis. Infectious Diseases Society of America. Clin Infect Dis. 2000;30(4):S662-S678.
Mora-Duarte J, Betts R, Rotstein C, et al. Comparison of caspofungin and amphotericin B for invasive candidiasis. N Engl J Med. 2002;347(25):S2020-S2029.
Kuse ER, Chetchotisakd P, da Cunha CA, et al. Micafungin versus liposomal amphotericin B for candidaemia and invasive candidosis: a phase III randomised double-blind trial. Lancet. 2007;369(9572):S1519-S1527.
Reboli AC, Shorr AF, Rotstein C, et al. Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome. BMC Infect Dis. 2011;11:261.
Cornely OA, Bassetti M, Calandra T, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18(7):S19-S37.
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4):S1-S50.
eisTIK.net, K.K.M.S. GmbH, Editor; 2019.
Mellinghoff SC, Hoenigl M, Koehler P, et al. EQUAL Candida score: an ECMM score derived from current guidelines to measure QUAlity of Clinical Candidaemia Management. Mycoses. 2018;61(5):S326-S330.
Huang HY, Lu PL, Wang YL, Chen TC, Chang K, Lin SY. Usefulness of EQUAL Candida scores for predicting outcomes in patients with candidemia: a retrospective cohort study. Clin Microbiol Infect. 2020;26(20):S1198.
Koehler P, Arendrup MC, Arikan-Akdagli S, et al. ECMM CandiReg-A ready to use platform for outbreaks and epidemiological studies. Mycoses. 2019;62(10):S920-S927.
Cisterna R, Ezpeleta G, Tellería O, et al. Nationwide sentinel surveillance of bloodstream Candida infections in 40 tertiary care hospitals in Spain. J Clin Microbiol. 2010;48(11):S4200-S4206.
Calandra T, Roberts JA, Antonelli M, Bassetti M, Vincent JL. Diagnosis and management of invasive candidiasis in the ICU: an updated approach to an old enemy. Crit Care. 2016;20(1):S125.
Kett DH, Azoulay E, Echeverria PM, Vincent JL. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med. 2011;39(4):S665-S670.
Marchetti O, Bille J, Fluckiger U, et al. Epidemiology of candidemia in Swiss tertiary care hospitals: secular trends, 1991-2000. Clin Infect Dis. 2004;38(3):S311-S320.
Andes DR, Safdar N, Baddley JW, et al. 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):S1110-S1122.
Vena A, Muñoz P, Padilla B, et al. Is routine ophthalmoscopy really necessary in candidemic patients? PLoS One. 2017;12(10):e0183485.
Lefort A, Chartier L, Sendid B, et al. Diagnosis, management and outcome of Candida endocarditis. Clin Microbiol Infect. 2012;18(4):E99-E109.
Fernández-Cruz A, Cruz Menárguez M, Muñoz P, et al. The search for endocarditis in patients with candidemia: a systematic recommendation for echocardiography? A prospective cohort. Eur J Clin Microbiol Infect Dis. 2015;34(8):S1543-S1549.
Pappas PG, Rotstein CM, Betts RF, et al. Micafungin versus caspofungin for treatment of candidemia and other forms of invasive candidiasis. Clin Infect Dis. 2007;45(7):S883-S893.
Fischer F, Lange K, Klose K, Greiner W, Kraemer A. Barriers and strategies in guideline implementation-a scoping review. Healthcare (Basel). 2016;4(3):36.
Lagrou K, Van Wijngaerden E. Infectious disease consultation lowers candidaemia mortality. Lancet Infect Dis. 2019;19(12):S1270-S1272.
Mejia-Chew C, O'Halloran JA, Olsen MA, et al. Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study. Lancet Infect Dis. 2019;12:1336-1344.
Kullberg BJ, Viscoli C, Pappas PG, et al. Isavuconazole versus caspofungin in the treatment of candidemia and other invasive candida infections: the ACTIVE trial. Clin Infect Dis. 2019;68(12):S1981-S1989.
Reboli AC, Rotstein C, Pappas PG, et al. Anidulafungin versus fluconazole for invasive candidiasis. N Engl J Med. 2007;356(24):S2472-S2482.
Vazquez J, Reboli AC, Pappas PG, et al. Evaluation of an early step-down strategy from intravenous anidulafungin to oral azole therapy for the treatment of candidemia and other forms of invasive candidiasis: results from an open-label trial. BMC Infect Dis. 2014;14:97.
Mellinghoff SC, Hartmann P, Cornely FB, et al. Analyzing candidemia guideline adherence identifies opportunities for antifungal stewardship. Eur J Clin Microbiol Infect Dis. 2018;37(8):S1563-S1571.