Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis
| Autor: | Francesc Marco, Patricia Muñoz, Benito Almirante, for Grupo de Estudio de Micología Médica, Carolina Garcia-Vidal, Josefina Ayats, Eva González-Barberá, Mario Fernández-Ruiz, Red Española de Investigación en Patología Infecciosa, Yolanda Meije, Adriana Manzur, José María Aguado, Celia Cardozo, Jordi Carratalà, María José Blanco-Vidal, José Miguel Montejo, Mireia Puig-Asensio, Antonio Vena, Carlota Gudiol, Guillermo Cuervo, Javier Pemán |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Male echinocandin therapy medicine.medical_specialty Antifungal Agents Echinocandin Urinary system 030106 microbiology Candida glabrata Comorbidity Microbial Sensitivity Tests Cohort Studies 03 medical and health sciences Echinocandins Internal medicine Candida albicans medicine Humans candidemia propensity score urinary source Renal Insufficiency Fluconazole Aged Aged 80 and over biology business.industry Odds ratio Middle Aged medicine.disease biology.organism_classification bacterial infections and mycoses Surgery Infectious Diseases Treatment Outcome Concomitant Propensity score matching Multivariate Analysis Urinary Tract Infections Female business medicine.drug |
| Zdroj: | CLINICAL INFECTIOUS DISEASES r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe instname |
| ISSN: | 1058-4838 |
| Popis: | Background. Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes. Methods. A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model. Results. Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P=.730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P=.047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI,.02-.31; P |
| Databáze: | OpenAIRE |
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