The Effect on Mortality of Fluconazole or Echinocandins Treatment in Candidemia in Internal Medicine Wards
| Autor: | Claudia Filippini, Giovanni Di Perri, C. Montrucchio, Rossana Cavallo, Stefania Raviolo, Alessia Petrolo, Silvia Corcione, Chiara Aldieri, Lucina Fossati, Francesco Giuseppe De Rosa |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment lcsh:Medicine Sepsis chemistry.chemical_compound Echinocandins Risk Factors Internal medicine Epidemiology Patients' Rooms medicine Internal Medicine Humans lcsh:Science Fluconazole Aged Multidisciplinary business.industry Mortality rate Incidence (epidemiology) lcsh:R Candidemia Correction Retrospective cohort study Middle Aged medicine.disease bacterial infections and mycoses chemistry Multivariate Analysis lcsh:Q Female Caspofungin business Central venous catheter medicine.drug Research Article |
| Zdroj: | PLoS ONE PLoS ONE, Vol 10, Iss 5, p e0125149 (2015) |
| ISSN: | 1932-6203 |
| Popis: | The incidence of candidemia has increased over the past two decades, with an increased number of cases in Internal Medicine and a prevalence ranging from 24% to 57%. This single-center retrospective study was performed to evaluate the epidemiology and the risk factors associated with mortality of candidemia in patients admitted to Internal Medicine wards (IMWs) of the City of Health and Sciences, Molinette Hospital, Turin, from January 2004 to December 2012. For each patient, demographic, clinical and microbiological data were collected. A case of candidemia was defined as a patient with at least one blood culture positive for Candida spp. Amongst 670 episodes of candidemia, 274 (41%) episodes occurred in IMWs. The mortality was 39% and was associated at multivariate analysis with sepsis, cirrhosis and neurologic diseases, whilst removal of central venous catheter ≤48h was significantly associated with survival. In the 77 patients treated with early antifungal therapy the mortality was 29% and was not significantly different with caspofungin or fluconazole, whilst in patients with definitive therapy the mortality was significantly lower with echinocandins compared to fluconazole (11.7% Vs. 39%; p=0.0289), a finding confirmed by multivariate analysis. The mortality was significantly associated with sepsis, cirrhosis and neurologic diseases, whilst CVC removal ≤48h was associated with survival. In patients with early therapy, fluconazole or caspofungin were equally effective. However, echinocandins were significantly more effective as definitive treatment, a finding not explained by differences in treatment delays. Further studies are needed to understand the full potential of these different therapeutic strategies in IMWs. |
| Databáze: | OpenAIRE |
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