1444Comparative effectiveness of fungicidal vs fungistatic therapies for the treatment of pediatric candidemia
Year: 2014
Type: conference-abstract
Abstract: Background. Patient-level review of adult clinical trial data concluded that echinocandin therapy for treatment of candidemia was associated with a decreased mortality rate. Limited data are available comparing options for systemic antifungal therapy in children. We compared the effectiveness of fungicidal vs fungistatic agents as definitive therapy for pediatric candidemia on 30-day all-cause mortality. Methods. All pediatric inpatients (> 6 months and <19 years of age) diagnosed with candidemia between 2000 and 2012 at the Children's Hospital of Philadelphia were retrospectively identified. Clinical and laboratory data were abstracted using a structured data collection tool. Candidemic patients were included in the final data analysis if they received the same antifungal agent for two consecutive days following candidemia onset. Amphotericin products and echinocandins were categorized as fungicidal and fluconazole as fungistatic. A propensity score model was used to generate inverse probability weights for receiving a fungicidal agent. These inverse weights were included in a weighted logistic regression model to compare 30-day mortality in fungicidal vs fungistatic recipients. Results. Among 203 children with candidemia that received the same antifungal agent for two consecutive days after culture was known positive, 151 (74.4%) received either amphotericin (n = 134) or caspofungin (n = 17) and 52 (25.6%) received fluconazole. Overall, 18 (8.9%) patients died within 30 days. In the weighted logistic regression model there was no statistically significant difference in mortality between patients that started on a fungicidal agent as compared to fungistatic therapy (OR: 2.19, 95% CI: 0.42 to 11.48). Conclusion. In a propensity score weighted model, initiation of definitive therapy with a fungicidal agent did not result in a significant decrease in 30-day mortality. These data suggest that both fungicidal and fungistatic agents can be considered as definitive therapy for pediatric candidemia. The results should be interpreted with caution given the small sample size and resultant wide confidence intervals. Larger pediatric cohort studies are needed to further compare antifungal therapeutic options and outcomes. Disclosures. T. Zaoutis, Merck: Investigator, Research grant; Consultant, Consulting fee; Pfizer: Consultant, Consulting fee; Astellas: Consultant, Consulting fee
Source: Open Forum Infectious Diseases
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2298423763