MSG12: Comparative Effectiveness of Echinocandins Versus Fluconazole Therapy for the Treatment of Adult Candidemia Due to Candida parapsilosis
Year: 2015
Type: conference-abstract
Abstract: Background. The 2009 Infectious Diseases Society of America (IDSA) guidelines for the treatment of Candida infections recommended fluconazole for Candida parapsilosis blood stream infections (BSI). Recent publications are conflicting regarding the role for echinocandins for C. parapsilosis BSI. A European cohort found that initial echinocandin therapy was not worse compared to fluconazole for patients with C. parapsilosis BSI. We aimed to compare the effectiveness of fluconazole versus echinocandins for the management of C. parapsilosis BSI in a U.S. population. Methods. A cohort of adults >19 years of age was assembled using Premier Perspective Database, a large database of billing and culture data. All incident admissions between 2009 and 2013 inclusive of a C. parapsilosisBSI were included. A weighted logistic regression model was used to compare the 30-day mortality between patients receiving initial therapy with an echinocandin versus fluconazole. A propensity score model was used to generate inverse probability weights for receiving an echinocandin. Initial therapy was defined as the antifungal agent given on the third day after the blood culture was drawn. Patients transferred from another institution and those who died prior to 4 days after the blood culture was drawn were excluded from the analysis. Results. There were 2582 admissions with a Candida BSI; 307 (12%) were due to C. parapsilosis. 126 (41%) patients received fluconazole as initial therapy and 181 (59%) received an echinocandin. The cohort's median age was 60, majority were male (57%), and the 30-day mortality was 9.8%. In a weighted logistic regression model there was no statistically significant difference in mortality between patients receiving initial therapy with echinocandins compared to fluconazole (OR: 1.14, 95% CI: 0.46 to 2.81). Conclusion. Initial therapy with an echinocandin for a C. parapsilosis BSI was not associated with an increase in 30-day mortality when compared with fluconazole in a propensity score weighted model. These data further the support the updated (2015) IDSA candidiasis guidelines that do not favor fluconazole over echinocandins for treatment of C. parapsilosis BSI. Additional research is warranted to investigate differences in time to clearance of candidemia and for other morbidity outcomes. Disclosures. N. Vendetti, Merck: Research Contractor, Research support; J. Baddley, Pfizer: Consultant, Consulting fee. BMS: Grant Investigator, Research grant; T. Zaoutis, Merck: Grant Investigator, Research grant; B. T. Fisher, Pfizer: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant
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: W2403351779