Empirical and targeted therapy of candidemia with fluconazole versus echinocandins: a propensity score–derived analysis of a population-based, multicentre prospective cohort
| Autor: | L.E. López-Cortés, B. Almirante, M. Cuenca-Estrella, J. Garnacho-Montero, B. Padilla, M. Puig-Asensio, I. Ruiz-Camps, J. Rodríguez-Baño, P. Muñoz, J. Guinea, J.R. Paño Pardo, J. García-Rodríguez, C. García Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos Gil, V. Buendía, B. Pérez Gorricho, M. Alonso, F. Sanz Sanz, J. María Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J.E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I. Sánchez Romero, O. Zaragoza, A.I. Suarez, A. Loza, A.I. Aller García, E. Martín-Mazuelos, M.R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F.L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J.J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernáez, G. Ezpeleta, E. Bereciartua, J.L. Hernández Almaraz, M. Montejo, R.A. Rivas, R. Ayarza, A.M. Planes, I. Ruiz Camps, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martinez-Montauti, M. Sierra, J.P. Horcajada, L. Sorli, J. Gómez, A. Gené, M. Urrea, M. Valerio, A. Díaz-Martín, F. Puchades, A. Mularoni |
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| Přispěvatelé: | [Lopez-Cortes, L. E.] Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain, [Rodriguez-Bano, J.] Hosp Univ Virgen Macarena, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain, [Lopez-Cortes, L. E.] Hosp Univ Virgen del Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain, [Rodriguez-Bano, J.] Hosp Univ Virgen del Rocio, Unidad Clin Enfermedades Infecciosas Microbiol &, IBiS, Seville, Spain, [Almirante, B.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain, [Puig-Asensio, M.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain, [Ruiz-Camps, I.] Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Dept Infect Dis, Barcelona, Spain, [Cuenca-Estrella, M.] Inst Salud Carlos III, Spanish Natl Ctr Microbiol, Dept Micol, Madrid, Spain, [Garnacho-Montero, J.] Hosp Univ Virgen Macarena, Unidad Clin Cuidados Intens, Seville, Spain, [Padilla, B.] Hosp Gen Univ Gregorio Maranon, Dept Clin Microbiol & Infect Dis, Madrid, Spain, [Rodriguez-Bano, J.] Univ Seville, Dept Med, Seville, Spain, Gilead Sciences, Pfizer, Instituto de Salud Carlos III, Astellas Pharma, bioMerieux, Merck Sharp and Dohme, Schering Plough, Soria Melguizo SA, Ferrer International, European Union, ALBAN programme, Spanish Agency for International Cooperation, Spanish Ministry of Culture and Education, Spanish Health Research Fund, Ramon Areces Foundation, Mutua Madrilena Foundation, Merck Sharp & Dohme de España, Novartis, bioMérieux, Schering-Plough, Fundación Francisco Soria Melguizo, European Commission, Ministerio de Asuntos Exteriores y Cooperación (España), Ministerio de Educación y Cultura (España), Ministerio de Sanidad, Servicios Sociales e Igualdad (España), Fundación Ramón Areces, Fundación Mutua Madrileña |
| Rok vydání: | 2016 |
| Předmět: |
Male
0301 basic medicine Identification Antifungal Agents Epidemiology Resistance Comorbidity Kaplan-Meier Estimate Anidulafungin Targeted therapy Echinocandins 0302 clinical medicine 030212 general & internal medicine Blood-stream infections Prospective cohort study Fluconazole education.field_of_study Surveillance Hazard ratio General Medicine Middle Aged Invasive candidiasis Treatment Outcome Impact Infectious Diseases Population Surveillance Female Cohort study medicine.drug Microbiology (medical) medicine.medical_specialty 030106 microbiology Population Outcomes Bloodstream infection 03 medical and health sciences Internal medicine medicine Humans Antifungal treatment Mortality Propensity Score education Aged Proportional Hazards Models business.industry Proportional hazards model Candidemia bacterial infections and mycoses Empirical therapy Confidence interval Surgery Bloodstream infections business |
| Zdroj: | CLINICAL MICROBIOLOGY AND INFECTION r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu instname r-FSJD: Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu Fundació Sant Joan de Déu Digital.CSIC. Repositorio Institucional del CSIC |
| ISSN: | 1198-743X |
| Popis: | CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI. We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17–0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41–1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia. BA has received grant support from Gilead Sciences, Pfizer and the Instituto de Salud Carlos III, and he has received honoraria for talks on behalf of Gilead Sciences, Merck Sharp and Dohme, Pfizer, Astellas and Novartis. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the European Union, the ALBAN programme, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III, the Ramon Areces Foundation and the Mutua Madrileña Foundation. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the European Union, the ALBAN programme, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III, the Ramon Areces Foundation and the Mutua Madrileña Foundation. |
| Databáze: | OpenAIRE |
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