Lars Jørgen Østergaard

Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment

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DOI

  • Karen Rokkedal Lausch
  • ,
  • Mette Søgaard, Department of Cardiology, Aalborg University Hospital, Hobrovej 18, -9000, Aalborg, DK, Denmark. ksm.alzuhairi@gmail.com., Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, 9000 Aalborg, Denmark.
  • ,
  • Flemming Schønning Rosenvinge, Department of Clinical Microbiology, Lillebaelt Hospital, 5500 Middelfart, Denmark.
  • ,
  • Helle Krogh Johansen, University of Copenhagen
  • ,
  • Trine Boysen, Department of Clinical Microbiology, Hvidovre Hospital, 2650 Hvidovre, Denmark.
  • ,
  • Bent Løwe Røder, Department of Clinical Microbiology, Hospital of Slagelse, Slagelse Sygehus, 4200 Slagelse, Denmark.
  • ,
  • Klaus Leth Mortensen
  • Lene Nielsen, Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: bente.ruth.scharvik.olesen@regionh.dk.
  • ,
  • Lars Lemming
  • ,
  • Bente Olesen, Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark. Electronic address: bente.ruth.scharvik.olesen@regionh.dk.
  • ,
  • Christine Leitz
  • ,
  • Lise Kristensen
  • ,
  • Esad Dzajic, Department of Clinical Microbiology, Sydvestjysk Sygehus, 6700 Esbjerg, Denmark.
  • ,
  • Lars Jørgen Østergaard
  • Henrik Carl Schønheyder
  • Maiken Cavling Arendrup, University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Copenhagen 2200, Denmark.

Background: In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes.

Materials and methods: Incident candidemia cases from a 2-year period, 2010-2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression.

Results: A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55-1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28-0.89), but not for patients with Candida albicans or Candida tropicalis.

Conclusion: The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted.

Original languageEnglish
JournalInfection and drug resistance
Volume11
Pages (from-to)2449-2459
Number of pages11
ISSN1178-6973
DOIs
Publication statusPublished - 2018

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