Work

Initial Treatment of Cancer Patients with Fluconazole-Intermediate C. glabrata Fungemia With an Echinocandin or Polyene is Associated With Better Survival Than Initial Treatment With an Azole

Year: 2016

Type: article

Abstract: Background. Candida glabrata is among the 2–3 most frequent Candida species causing invasive candidiasis, and the main species developing multidrug resistance. In population studies, up to 2/3 of C. glabrata isolates are non-susceptible to azoles, which should be used with caution against this pathogen. However, some studies showed comparable clinical outcomes between azoles and echinocandins for treatment of C. glabrata infections. We compared all-cause mortality between cancer patients with C. glabrata fungemia treated within the first 48 hours after blood culture collection with an azole and those treated with an echinocandin or polyene. Methods. We identified cancer patients with ≥1 blood culture(s) positive for fluconazole-intermediate (MIC <32 mg/L) C. glabrata seen at M. D. Anderson Cancer Center between March 2005 and September 2013, who received antifungal treatment within the first 48 hours after blood culture collection. We retrospectively reviewed their clinical and laboratory data on the day of blood culture collection. Results. We studied 75 patients; 36 (48%) were female and the mean age (standard deviation) was 53 (16). Twelve patients (16%) had acute leukemia, and 16 (21%) were neutropenic (<500 neutrophils/μL).The 28-day survival was 62% (28/45) with initial echinocandin or polyene and 47% (14/30) with initial azole treatment. In neutropenic patients, 28-day survival was 56% (5/9) with initial echinocandin or polyene and 29% (2/7) with initial azole treatment. In multivariate Cox regression analysis, ICU stay (HR 3, p = 0.01), APACHE II score (HR 1.1 per unit, p = 0.04), monocytopenia (<100 monocytes/μL, HR 4.4, p < 0.001), absence of fever (HR 2.2, p = 0.04), and azole monotherapy within the first 48 hours after blood culture collection (HR 2.2, p = 0.03) were associated with increased 28-day mortality. Conclusion. In this small series of cancer patients with C. glabrata fungemia, excluding those who did not receive an antifungal or had fluconazole-resistant isolates, we noted a trend towards increased all-cause mortality with azole monotherapy, after adjustment for other clinical confounders. Azole monotherapy as initial treatment should be avoided in cancer patients with suspected C. glabrata fungemia, even in those without neutropenia. Disclosures. D. P. Kontoyiannis, â€¢: Advisory Board, Research support Pfizer: Research grant, Research support Gilead: Invited lecturer, Speaker honorarium Astellas: Consultant, Research support and Speaker honorarium F2G: Consultant, Consulting fee T2 Biosystems: Invited lecturer, Speaker honorarium Mylan Inc: Invited lecturer, Speaker honorarium

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofw172.1298

Authors: Dimitrios Farmakiotis, Audrey Le, Jeffrey Tarrand, Dimitrios P. Kontoyiannis

Institutions: Brown University, The University of Texas MD Anderson Cancer Center

Language: English

Topic: Antifungal resistance and susceptibility

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $4,053