Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes Journal Article

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Authors: Grim, S. A.; Berger, K; Teng, C.; Gupta, S; Layden, J. E.; Janda, W. M.; Clark, N. M.
Article Title: Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: correlation with outcomes
Abstract: OBJECTIVES: We sought to determine the impact of timing of appropriate antifungal therapy, as assessed by susceptibility results, on patient survival. METHODS: Patients >/=16 years of age with first episodes of candidaemia during 2001-09 were included. Clinical data were collected retrospectively, including time to appropriate antifungal therapy and patient survival. RESULTS: The study population included 446 patients [243 (54%) female, mean age 53 years] with candidaemia, 380 (85%) of whom had antifungal susceptibility data. Candida albicans was the most common pathogen (221, 50%) followed by Candida glabrata (99, 22%), Candida parapsilosis (59, 13%), Candida tropicalis (48, 11%) and Candida krusei (6, 1%). Appropriate antifungal therapy consisted of fluconazole (177, 40%), an echinocandin (125, 28%), amphotericin B (41, 9%) and voriconazole (6, 1%); 97 (22%) failed to receive appropriate antifungal therapy. The 30 day mortality was 34% (151/446) and there was no clear relationship between time from positive culture to receipt of appropriate antifungal therapy and 30 day survival. On multivariable Cox regression, increased APACHE II score [hazard ratio (HR) 1.11, 95% CI 1.09-1.13, P/=24 h of effective antifungal therapy did show a significant mortality benefit to receiving antifungal treatment within 72 h of a positive blood culture being drawn (30 day mortality for early treatment: 27% versus 40%, P=0.004; HR for mortality with delayed treatment on multivariable analysis: 1.41, 95% CI 1.01-1.98, P=0.045). CONCLUSIONS: Candida bloodstream infection is associated with high mortality, despite timely receipt of appropriate antifungal therapy.
Journal Title: The Journal of antimicrobial chemotherapy
Volume: 67
Issue: 3
ISSN: 1460-2091; 0305-7453
Publisher: . Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy  
Journal Place: England
Date Published: 2012
Start Page: 707
End Page: 714
Language: eng
DOI/URL:

10.1093/jac/dkr511

10.1093/jac/dkr511
Notes: ID: 12856; JID: 7513617; 0 (Antifungal Agents); 2011/12/18 [aheadofprint]; ppublish