Impact of inappropriate antifungal therapy according to current susceptibility breakpoints on Candida bloodstream infection mortality, a retrospective analysis

• Published in: BMC infectious diseases Vol. 17; no. 1; pp. 753 - 9
• Main Authors: González-Lara, María Fernanda, Torres-González, Pedro, Cornejo-Juárez, Patricia, Velázquez-Acosta, Consuelo, Martinez-Gamboa, Areli, Rangel-Cordero, Andrea, Bobadilla-Del-Valle, Miriam, Ostrosky-Zeichner, Luis, Ponce-de-León, Alfredo, Sifuentes-Osornio, José
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.12.2017; BioMed Central; BMC
• Subjects: Adult; Analysis; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Antifungal susceptibility testing; Candida albicans - drug effects; Candida albicans - isolation & purification; Candida bloodstream infections; Candida glabrata - drug effects; Candida glabrata - isolation & purification; Candidemia - drug therapy; Candidemia - microbiology; Candidemia - mortality; Candidemia - pathology; Candidemia treatment; Disease susceptibility; Drug Resistance, Fungal; Female; Fluconazole - pharmacology; Fluconazole - therapeutic use; Fluconazole resistance; Health aspects; Humans; Infection; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Retrospective Studies; Sepsis - drug therapy; Sepsis - microbiology; Sepsis - mortality; Sepsis - pathology; Severity of Illness Index; Tertiary Care Centers; Fluconazole resistance; Antifungal susceptibility testing; Candidemia treatment; Candida bloodstream infections
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-017-2846-2

The mortality of Candida Bloodstream Infection (CBSI) remains high. Antifungal susceptibility breakpoints were recently updated for Candida species, the impact remains unknown. In this study we evaluated the impact of inappropriate antifungal treatment according to recent breakpoints on 30-day mortality of CBSI. From June 2008 to July 2014, data on CBSI episodes from two tertiary-care centers, treated > 72 h were analyzed. Antifungal therapy and 30-day mortality were registered. Inappropriate antifungal treatment according to current Clinical & Laboratory Standards Institute (CLSI) breakpoints was adjusted with 30-day mortality-related co-variates. One hundred forty-nine episodes of CBSI were analyzed. The most frequent species were: C. albicans (40%), C. tropicalis (23%) and C. glabrata complex (20%). According to the 2012 CLSI, 10.7% received inappropriate treatment. The 30-day mortality was 38%; severe sepsis [Odds ratio (OR) 3.4; 95% CI 1.3-8.4], cirrhosis (OR 36; 95% CI 12.2-605), early central venous catheter removal (OR 0.23; 95% CI 0.08-0.66) and previous antifungal therapy (OR 0.15; 95%CI 0.03-0.62), were associated with 30-day mortality by multivariate analysis. Inappropriate antifungal treatment was not (OR 0.19; 95% CI 0.03-1.2). Appropriate antifungal therapy according to CLSI 2012 did not have an impact on mortality. Mortality of CBSI remains high due to disease severity and comorbidities; early antifungal therapy and catheter removal may reduce it.