Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Enrollment and Antifungal Susceptibility Data
2.2. Statistical Analyses
3. Results
4. Discussion
Author Contributions
Funding
Conflicts of Interest
References
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Species | Number | Anidulafungin | Fluconazole | Voriconazole | Posaconazole | Amphotericin B | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
S | R | S | R | S | R | S | R | S | R | ||
C. albicans | 72 | 96 | 4 | 100 | 0 | 100 | 0 | 95 | 5 | 100 | 0 |
C. glabrata | 24 | 100 | 0 | 0 | 100 | 80 | 20 | 45 | 55 | 100 | 0 |
C. parapsilosis | 18 | 5 | 95 | 78 | 22 | 100 | 0 | 94 | 6 | 100 | 0 |
C. tropicalis | 5 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 | 100 | 0 |
C. krusei | 4 | 100 | 0 | 0 | 100 | 100 | 0 | 50 | 50 | 100 | 0 |
Variables | Number of Patients (%) |
---|---|
Demographic parameters | |
Age, range | Median 63 years, range 22–91 |
Male gender | 70 (75%) |
Medical ward | 39 (32%) |
Surgical ward | 62 (50%) |
Others | 22 (18%) |
ICU stay (overall) | 61 (49%) |
Treatment | |
Empirical treatment | 53 (43%) |
Antifungal drugs used as first-line treatment | |
Caspofungin | 38 (31%) |
Fluconazole | 35 (28%) |
Anidulafungin | 31 (25%) |
Micafungin | 12 (10%) |
Voriconazole | 5 (4%) |
Posaconazole | 1 (1%) |
Fluconazole and Flucytosine | 1 (1%) |
Days until fungal clearance | Median 5.6 days, range 2–12 |
Outcome | |
14-day fungal free blood cultures | 123 (100%) |
Species (Patients) | Antifungal Drug Resistance | Primary Therapy (Patients) | Antifungal Switch | 14-Day Fungal Free Blood Cultures | Open Questions Based on International Guideline Recommendations and Candida Species and MIC Values Reported |
---|---|---|---|---|---|
C. albicans (n = 3) | ANI | CAS | MICA & l-AmB ISA | ✓ | The switch from CAS to MICA is unclear? |
CAS | ✓ | The application of ISA, which is not licensed for Candida therapy is unclear? | |||
CAS | ✓ | The application of CAS despite ANI resistance is unclear? | |||
C. glabrata (n = 14) | FLU ANI | FLU (7) | FLU & ANI CAS | ✓ | The application of FLU in C. glabrata and FLU resistance being present is unclear? |
FLU | ✓ | Why not stopping FLU when adding ANI? | |||
ANI | ✓ | Why a change from ANI to CAS in such case? | |||
ANI (5) | ✓ | The application of ANI despite ANI resistance being present is unclear? | |||
C. parapsilosis (n = 6) | ANI ANI/FLU FLU | CAS | MICA | ✓ | The switch from CAS to MICA despite ANI resistance being present is unclear? |
ANI (2) | ✓ | ANI treatment despite ANI resistance being present? | |||
CAS | ✓ | CAS therapy despite ANI resistance? | |||
CAS | ✓ | Why CAS therapy despite ANI resistance? | |||
FLU | ✓ | The application of FLU despite FLU resistance being present is unclear? | |||
C. krusei (n = 1) | FLU | MICA | CAS | ✓ | Why change from MIC to CAS in case of FLU resistance being present? |
Variables | Univariate p Value |
---|---|
Age | 0.880 |
Gender | 0.259 |
Empirical treatment | 0.881 |
Targeted treatment | 0.881 |
MIC (antifungal susceptibility data)-correlated treatment | 0.713 |
MIC-non-correlated treatment | 0.867 |
Antifungal drug switch | 0.187 |
Intensive care unit | 0.744 |
Candida species involved | 0.570 |
Resistant isolates involved | 0.721 |
Susceptible isolates involved | 0.657 |
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Lass-Flörl, C.; Krause, R.; Willinger, B.; Starzengruber, P.; Decristoforo, P.; Neururer, S.; Kreidl, P.; Aigner, M. Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study. J. Fungi 2020, 6, 76. https://doi.org/10.3390/jof6020076
Lass-Flörl C, Krause R, Willinger B, Starzengruber P, Decristoforo P, Neururer S, Kreidl P, Aigner M. Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study. Journal of Fungi. 2020; 6(2):76. https://doi.org/10.3390/jof6020076
Chicago/Turabian StyleLass-Flörl, Cornelia, Robert Krause, Birgit Willinger, Peter Starzengruber, Petra Decristoforo, Sabrina Neururer, Peter Kreidl, and Maria Aigner. 2020. "Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study" Journal of Fungi 6, no. 2: 76. https://doi.org/10.3390/jof6020076