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Title: Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: Correlation with outcomes
Authors: Grim, S.A.
Berger, K.
Teng, C. 
Gupta, S.
Layden, J.E.
Janda, W.M.
Clark, N.M.
Keywords: Candidaemia
Issue Date: Mar-2012
Citation: Grim, S.A., Berger, K., Teng, C., Gupta, S., Layden, J.E., Janda, W.M., Clark, N.M. (2012-03). Timing of susceptibility-based antifungal drug administration in patients with Candida bloodstream infection: Correlation with outcomes. Journal of Antimicrobial Chemotherapy 67 (3) : 707-714. ScholarBank@NUS Repository.
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,0.001], cirrhosis (HR 2.15, 95% CI 1.48-3.13, P,0.001) and HIV infection (HR 2.03, 95% CI 1.11-3.72, P=0.02) were independent predictors of mortality. A secondary analysis requiring patients in the early treatment group to have received ≥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. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Source Title: Journal of Antimicrobial Chemotherapy
ISSN: 03057453
DOI: 10.1093/jac/dkr511
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