Therapeutic Approaches in Patients With Candidemia: Evaluation in a Multicenter, Prospective, Observational Study
Abstract
OBJECTIVES: To evaluate the morbidity and mortality of Candida fungemia and to assess the efficacy of low- vs high-dose amphotericin B and fluconazole vs amphotericin B in patients with candidemia. METHODS: Multicenter, prospective, observational study of 427 consecutive patients with candidemia. RESULTS: The mortality rate for patients with candidemia was 34%. The mortality rate for patients with catheter-related candidemia in whom the catheters were retained was significantly higher than that of patients in whom the catheters were removed (41% vs 21%, P < .001). We found no overall difference in mortality in patients treated with low-dose (total amphotericin B dose of < or = 500 mg) (13%) vs high-dose amphotericin B (total amphotericin B dose of > 500 mg) (15%), but the group treated with a low dose had fewer side effects (40%) than those treated with a high dose (55%) (P = .03). Fluconazole was as efficacious as amphotericin B in the therapy of candidemia, even when stratified by risk factors for mortality. Fewer side effects were seen with fluconazole (12%) compared with amphotericin B (44%) (P < .001). CONCLUSIONS: In selected patients with candidemia, low-dose amphotericin B was as efficacious as high-dose amphotericin B. Based on other studies and ours, fluconazole seems to be an alternative therapeutic option to amphotericin B in selected patients.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Two large randomized studies and 2 large observational studies have demonstrated that fluconazole (400 mg/day) and amphotericin B deoxycholate (0.5-0.6 mg/kg per day) are similarly effective as therapy.
“Two large randomized studies [105, 106] and 2 large observational studies [107, 108] have demonstrated that fluconazole (400 mg/day) and amphotericin B deoxycholate (0.5-0.6 mg/kg per day) are similarly effective as therapy.”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [108]
In an individual patient, it is difficult to determine the relative contributions of the gut and a catheter as primary sources of fungemia.
“in an individual patient, it is difficult to determine the relative contributions of the gut and a catheter as primary sources of fungemia [107,108,118].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [108]
In neutropenic patients, the gut is a source for disseminated candidiasis, evident from autopsy studies.
“In neutropenic patients, the role of the gut as a source for disseminated candidiasis is evident from autopsy studies”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [108]
Catheter removal is associated with reduced mortality in adults and neonates with candidemia.
“includes data in which catheter removal was associated with reduced mortality in adults [108, 116] and neonates [117].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [108]
Cites
Rex, J. H., Bennett, J. E., Sugar, A. M., Pappas, P. G., van der Horst, C. M., Edwards, J. E., Washburn, R. G., Scheld, W. M., Karchmer, A. W., Dine, A. P., et al. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411173312001 · Cited by 1,039 · see citing works
Enterobacter Bacteremia: Clinical Features and Emergence of Antibiotic Resistance during Therapy
Chow, J. W., Fine, M. J., Shlaes, D. M., Quinn, J. P., Hooper, D. C., Johnson, M. P., Ramphal, R., Wagener, M. M., Miyashiro, D. K., & Yu, V. L. (1991) · Annals of Internal Medicine · doi:10.7326/0003-4819-115-8-585 · Cited by 887 · see citing works
Hospital-Acquired Candidemia: The Attributable Mortality and Excess Length of Stay
Wey, S. B. (1988) · Archives of Internal Medicine · doi:10.1001/archinte.1988.00380120094019 · Cited by 831 · see citing works
Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality.
Fraser, V. J., Jones, M., Dunkel, J., Storfer, S., Medoff, G., & Dunagan, W. C. (1992) · Clinical Infectious Diseases · doi:10.1093/clind/15.3.414 · Cited by 679 · see citing works
Hilf, M., Yu, V. L., Sharp, J., Zuravleff, J. J., Korvick, J. A., & Muder, R. R. (1989) · The American Journal of Medicine · doi:10.1016/s0002-9343(89)80611-4 · Cited by 560 · see citing works
Fungemia in a Cancer Hospital: Changing Frequency, Earlier Onset, and Results of Therapy
Horn, R., Wong, B., Kiehn, T. E., & Armstrong, D. (1985) · Clinical Infectious Diseases · doi:10.1093/clinids/7.5.646 · Cited by 479 · see citing works
Fungemia in the immunocompromised host
Meunier-Carpentier, F., Kiehn, T. E., & Armstrong, D. (1981) · The American Journal of Medicine · doi:10.1016/0002-9343(81)90162-5 · Cited by 459 · see citing works
Komshian, S. V., Uwaydah, A. K., Sobel, J. D., & Crane, L. R. (1989) · Clinical Infectious Diseases · doi:10.1093/clinids/11.3.379 · Cited by 456 · see citing works
Vascular Catheter-Associated Fungemia in Patients with Cancer: Analysis of 155 Episodes
Lecciones, J. A., Lee, J. W., Navarro, E. E., Witebsky, F. G., Marshall, D., Steinberg, S. M., Pizzo, P. A., & Walsh, T. J. (1992) · Clinical Infectious Diseases · doi:10.1093/clinids/14.4.875 · Cited by 317 · see citing works
Intraocular Candidiasis in Patients with Candidemia
Donahue, S. P., Greven, C. M., Zuravleff, J. J., Eller, A. W., Nguyen, M. H., Peacock, J. E., Wagener, M. M., & Yu, V. L. (1994) · Ophthalmology · doi:10.1016/s0161-6420(94)31175-4 · Cited by 239 · see citing works
Self-citationEdwards, J. E. (1991) · New England Journal of Medicine · doi:10.1056/nejm199104113241511 · Cited by 222 · see citing works
Anaissie, E. J., Bodey, G. P., Kantarjian, H. M., David, C. L., Barnett, K., Bow, E. J., DeFelice, R., Downs, N., File, T. M., Karam, G. A., et al. (1991) · The American Journal of Medicine · doi:10.1016/0002-9343(91)90006-j · Cited by 217 · see citing works
Korvick, J. A., Bryan, C. S., Farber, B. Y., Beam, T. R., Schenfeld, L. A., Muder, R. R., WEINBAUM, D. L., Lumish, R. M., Gerding, D. N., & Wagener, M. M. (1992) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.36.12.2639 · Cited by 212 · see citing works
Hepatosplenic candidiasis: Successful treatment with fluconazole
Kauffman, C. A., Bradley, S., Ross, S. C., & Weber, D. R. (1991) · The American Journal of Medicine · doi:10.1016/0002-9343(91)90005-i · Cited by 193 · see citing works
Outcome of treatment of candidemia in children whose central catheters were removed or retained.
Sc, E., TROUTMAN, J. L., & Lt, G. (1989) · PubMed · Cited by 180 · see citing works
Candidemia in children with central venous catheters
Dato, V., & Dajani, A. S. (1990) · The Pediatric Infectious Disease Journal · doi:10.1097/00006454-199005000-00002 · Cited by 163 · see citing works
Candida Infections in Surgical Patients
Marsh, P. K., Tally, F. P., Kellum, J. M., Callow, A. D., & Gorbach, S. L. (1983) · Annals of Surgery · doi:10.1097/00000658-198307000-00008 · Cited by 152 · see citing works
Miller, P. J., & Wenzel, R. P. (1987) · The Journal of Infectious Diseases · doi:10.1093/infdis/156.3.471 · Cited by 134 · see citing works
Dyess, D. L. (1985) · Archives of Surgery · doi:10.1001/archsurg.1985.01390270083014 · Cited by 122 · see citing works
A new therapeutic approach to Candida infections. A preliminary report
Medoff, G. (1972) · Archives of Internal Medicine · doi:10.1001/archinte.130.2.241 · Cited by 103 · see citing works
Treatment of Candida albicans fungaemia with fluconazole
Graninger, W., Presteril, E., Schneeweiß, B., Teleky, B. K., & Georgopoulos, A. P. (1993) · Journal of Infection · doi:10.1016/0163-4453(93)92761-k · Cited by 97 · see citing works
Candida Infections in Surgical Patients Dose Requirements and Toxicity of Amphotericin B
Solomkin, J. S., Flohr, A. B., & Simmons, R. L. (1982) · Annals of Surgery · doi:10.1097/00000658-198202000-00010 · Cited by 84 · see citing works
Treatment of Candidemia in Critically Ill Surgical Patients with Intravenous Fluconazole
Nolla‐Salas, J., Leon, C. C. D., Torres-Rodrı́guez, J. M., Martin, E., & Sitges‐Serra, A. (1992) · Clinical Infectious Diseases · doi:10.1093/clinids/14.4.952 · Cited by 38 · see citing works
Yeast in blood cultures evaluation of factors influencing outcome
Bryce, E., Roberts, F. J., Sekhon, A. S., & Coldman, A. J. (1992) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/0732-8893(92)90118-d · Cited by 31 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/civ933 · Cited by 4,200 · see citing works
Mermel, L. A., Allon, M., Bouza, E., Craven, D. E., Flynn, P., O'Grady, N. P., Raad, I. I., Rijnders, B. J. A., Sherertz, R. J., & Warren, D. K. (2009) · Clinical Infectious Diseases · doi:10.1086/599376 · Cited by 3,638 · see citing works
Freifeld, A. G., Bow, E. J., Sepkowitz, K. A., Boeckh, M. J., Ito, J. I., Mullen, C. A., Raad, I. I., Rolston, K. V., Young, J.-A. H., & Wingard, J. R. (2011) · Clinical Infectious Diseases · doi:10.1093/cid/cir073 · Cited by 3,463 · see citing works
Pappas, P. G., Kauffman, C. A., Andes, D., Benjamin, D. K., Calandra, T. F., Edwards, J. E., Filler, S. G., Fisher, J. F., Kullberg, B.-J., Zeichner, L. O., et al. (2009) · Clinical Infectious Diseases · doi:10.1086/596757 · Cited by 3,191 · see citing works
Chandra, J., Kuhn, D. M., Mukherjee, P. K., Hoyer, L. L., McCormick, T., & Ghannoum, M. A. (2001) · Journal of Bacteriology · doi:10.1128/jb.183.18.5385-5394.2001 · Cited by 1,578 · see citing works
Guidelines for the management of intravascular catheter-related infections
Mermel, L. A., Farr, B. M., Sherertz, R. J., Raad, I. I., O'Grady, N., Harris, J. S., & Craven, D. E. (2001) · Clinical Infectious Diseases · doi:10.1086/320001 · Cited by 1,449 · see citing works
Guidelines for Treatment of Candidiasis
Pappas, P. G., Rex, J. H., Sobel, J. D., Filler, S. G., Dismukes, W. E., Walsh, T. J., & Edwards, J. E. (2004) · Clinical Infectious Diseases · doi:10.1086/380796 · Cited by 1,440 · see citing works
Comparison of Caspofungin and Amphotericin B for Invasive Candidiasis
Mora-Duarte, J., Betts, R., Rotstein, C., Colombo, A. L., Thompson-Moya, L., Smietana, J., Lupinacci, R., Sable, C., Kartsonis, N., & Perfect, J. (2002) · New England Journal of Medicine · doi:10.1056/nejmoa021585 · Cited by 1,380 · see citing works
Practice Guidelines for the Treatment of Candidiasis
Rex, J. H., Walsh, T. J., Sobel, J. D., Filler, S. G., Pappas, P. G., Dismukes, W. E., & Edwards, J. E. (2000) · Clinical Infectious Diseases · doi:10.1086/313749 · Cited by 927 · see citing works
Epidemiology of Candida species infections in critically ill non-immunosuppressed patients
Eggimann, P., Garbino, J., & Pittet, D. (2003) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(03)00801-6 · Cited by 900 · see citing works
The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance
Hong Nguyen, M., Peacock, J. E., Morris, A. J., Tanner, D. C., Nguyen, M. L., Snydman, D. R., Wagener, M. M., Rinaldi, M. G., & Yu, V. L. (1996) · The American Journal of Medicine · doi:10.1016/s0002-9343(95)00010-0 · Cited by 758 · see citing works
Self-citationNon-albicans Candida spp. causing fungaemia: pathogenicity and antifungal resistance
Krcmery, V., & Barnes, A. J. (2002) · Journal of Hospital Infection · doi:10.1053/jhin.2001.1151 · Cited by 733 · see citing works
Tissot, F., Agrawal, S., Pagano, L., Petrikkos, G., Groll, A. H., Skiada, A., Lass-Flörl, C., Calandra, T., Viscoli, C., & Herbrecht, R. (2017) · Haematologica · doi:10.3324/haematol.2016.152900 · Cited by 682 · see citing works
Mukherjee, P. K., Chandra, J., Kuhn, D. M., & Ghannoum, M. A. (2003) · Infection and Immunity · doi:10.1128/iai.71.8.4333-4340.2003 · Cited by 511 · see citing works
Rex, J. H., Pappas, P. G., Karchmer, A. W., Sobel, J., Edwards, J. E., Hadley, S., Brass, C., Vazquez, J. A., Chapman, S. W., Horowitz, H. W., et al. (2003) · Clinical Infectious Diseases · doi:10.1086/374850 · Cited by 495 · see citing works
Andes, D., Nett, J., Oschel, P., Albrecht, R., Marchillo, K., & Pitula, A. (2004) · Infection and Immunity · doi:10.1128/iai.72.10.6023-6031.2004 · Cited by 389 · see citing works
The Impact of Candidemia on Length of Hospital Stay, Outcome, and Overall Cost of Illness
Rentz, A. M., Halpern, M. T., & Bowden, R. (1998) · Clinical Infectious Diseases · doi:10.1086/514955 · Cited by 310 · see citing works
Predictors of Adverse Outcome in Cancer Patients with Candidemia
Anaissie, E. J., Rex, J. H., Uzun, Ö., & Vartivarian, S. (1998) · The American Journal of Medicine · doi:10.1016/s0002-9343(98)00030-8 · Cited by 295 · see citing works
Nolla-Salas, J., Sitges-Serra, A., León-Gil, C., Martínez-González, J., León-Regidor, M. A., Ibán˜ez-Lucí, P., & Torres-Rodríguez, J. M. (1997) · Intensive Care Medicine · doi:10.1007/s001340050286 · Cited by 263 · see citing works
Effects of nosocomial candidemia on outcomes of critically ill patients
Blot, S. I., Vandewoude, K. H., Hoste, E. A., & Colardyn, F. A. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(02)01248-2 · Cited by 235 · see citing works
Phillips, P., Shafran, S., Garber, G., Rotstein, C., Smaill, F., Fong, I., Salit, I., Miller, M., Williams, K., Conly, J. M., et al. (1997) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/bf01726360 · Cited by 221 · see citing works
Nguyen, M. H., Clancy, C. J., Yu, V. L., Yu, Y. C., Morris, A. J., Snydman, D. R., Sutton, D. A., & Rinaldi, M. G. (1998) · The Journal of Infectious Diseases · doi:10.1086/514193 · Cited by 219 · see citing works
Self-citationBodey, G. P., Mardani, M., Hanna, H. A., Boktour, M., Abbas, J., Girgawy, E., Hachem, R. Y., Kontoyiannis, D. P., & Raad, I. I. (2002) · The American Journal of Medicine · doi:10.1016/s0002-9343(01)01130-5 · Cited by 209 · see citing works
Treatment-related risk factors for hospital mortality in Candida bloodstream infections
Labelle, A. J., Micek, S. T., Roubinian, N., & Kollef, M. H. (2008) · Critical Care Medicine · doi:10.1097/ccm.0b013e31818b3477 · Cited by 181 · see citing works
Risk factors for death in patients with candidemia
Nucci, M., Colombo, A. L., Silveira, F., Richtmann, R., Salomão, R., Branchini, M. L., & Spector, N. (1998) · Infection Control & Hospital Epidemiology · doi:10.1086/647743 · Cited by 178 · see citing works
Should Vascular Catheters Be Removed from All Patients with Candidemia? An Evidence-Based Review
Nucci, M., & Anaissie, E. (2002) · Clinical Infectious Diseases · doi:10.1086/338714 · Cited by 175 · see citing works
Dupont, H. (2002) · Archives of Surgery · doi:10.1001/archsurg.137.12.1341 · Cited by 163 · see citing works
Management of central venous catheters in patients with cancer and candidemia
Raad, I., Hanna, H., Boktour, M., Girgawy, E., Danawi, H., Mardani, M., Kontoyiannis, D., Darouiche, R., Hachem, R., & Bodey, G. P. (2004) · Clinical Infectious Diseases · doi:10.1086/382874 · Cited by 159 · see citing works
St-Germain, G., Laverdière, M., Pelletier, R., Bourgault, A.-M., Libman, M., Lemieux, C., & Noël, G. (2001) · Journal of Clinical Microbiology · doi:10.1128/jcm.39.3.949-953.2001 · Cited by 134 · see citing works
Macphail, G. L. P., Taylor, G. D., Buchanan‐Chell, M., Ross, C., Wilson, S., & Kureishi, A. (2002) · Mycoses · doi:10.1046/j.1439-0507.2002.00741.x · Cited by 119 · see citing works
Tortorano, A. M., Biraghi, E., Astolfi, A., Ossi, C., Tejada, M., Farina, C., Perin, S., Bonaccorso, C., Cavanna, C., Raballo, A., et al. (2002) · Journal of Hospital Infection · doi:10.1053/jhin.2002.1261 · Cited by 116 · see citing works
Park, B. J., Arthington-Skaggs, B. A., Hajjeh, R. A., Iqbal, N., Ciblak, M. A., Lee-Yang, W., Hairston, M. D., Phelan, M., Plikaytis, B. D., Sofair, A. N., et al. (2006) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.50.4.1287-1292.2006 · Cited by 113 · see citing works
Treatment of Invasive Candidiasis: A Narrative Review
Ben-Ami, R. (2018) · Journal of Fungi · doi:10.3390/jof4030097 · Cited by 111 · see citing works
Chi, H.-W., Yang, Y.-S., Shang, S.-T., Chen, K.-H., Yeh, K.-M., Chang, F.-Y., & Lin, J.-C. (2011) · Journal of Microbiology, Immunology and Infection · doi:10.1016/j.jmii.2010.08.010 · Cited by 103 · see citing works
Criteria used when initiating antifungal therapy against Candida spp. in the intensive care unit
Muñoz, P., Burillo, A., & Bouza, E. (2000) · International Journal of Antimicrobial Agents · doi:10.1016/s0924-8579(00)00147-3 · Cited by 95 · see citing works
Outcome in critically ill patients with candidal fungaemia: Candida albicans vs. Candida glabrata
Blot, S., Vandewoude, K., Hoste, E., Poelaert, J., & Colardyn, F. (2001) · Journal of Hospital Infection · doi:10.1053/jhin.2000.0918 · Cited by 73 · see citing works
Impact of early central venous catheter removal on outcome in patients with candidaemia
Rodriguez, D., Park, B. J., Almirante, B., Cuenca-Estrella, M., Planes, A. M., Mensa, J., Gimenez, M., Saballs, P., Fridkin, S. K., Rodriguez-Tudela, J. L., et al. (2007) · Clinical Microbiology and Infection · doi:10.1111/j.1469-0691.2007.01758.x · Cited by 76 · see citing works
Occurrence, presentation and treatment of candidemia
Mikulska, M., Del Bono, V., Ratto, S., & Viscoli, C. (2012) · Expert Review of Clinical Immunology · doi:10.1586/eci.12.52 · Cited by 71 · see citing works
Risk factors for death among cancer patients with fungemia
Nucci, M., Silveira, M. I., Spector, N., Silveira, F., Velasco, E., Akiti, T., Barreiros, G., Derossi, A., Colombo, A. L., & Pulcheri, W. (1998) · Clinical Infectious Diseases · doi:10.1086/514609 · Cited by 69 · see citing works
Liu, C. Y., Huang, L. J., Wang, W. S., Chen, T. L., Yen, C. C., Yang, M. H., Hsiao, L. T., Liu, C. Y., Chen, P. M., & Chiou, T. J. (2009) · Journal of Infection · doi:10.1016/j.jinf.2008.12.008 · Cited by 67 · see citing works
Epidemiology of Candida blood stream infections: experience of a tertiary care centre in North India
Chander, J., Singla, N., Sidhu, S. K., & Gombar, S. (2013) · The Journal of Infection in Developing Countries · doi:10.3855/jidc.2623 · Cited by 61 · see citing works
Pasqualotto, A. C., de Moraes, A. B., Zanini, R. R., & Severo, L. C. (2007) · Infection Control & Hospital Epidemiology · doi:10.1086/516658 · Cited by 60 · see citing works
Ahmadi, M. S., Lee, H. H., Sanchez, D. A., Friedman, A. J., Tar, M. T., Davies, K. P., Nosanchuk, J. D., & Martinez, L. R. (2016) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.02659-15 · Cited by 41 · see citing works
Kovacicova, G., Krupova, Y., Lovaszova, M., Obertik, T., Krcmery, V., Roidova, A., Trupl, J., Liskova, A., Hanzen, J., Milosovic, P., et al. (2000) · Journal of Infection and Chemotherapy · doi:10.1007/s101560070006 · Cited by 39 · see citing works
Candidaemia in a large teaching hospital: a clinical audit
Aliyu, S. H. (2006) · QJM · doi:10.1093/qjmed/hcl087 · Cited by 31 · see citing works
- Authors
- Nguyen, M. H.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Nguyen, M. Hong
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1995-12-11
- Volume
- 155
- Issue
- 22
- Pages
- 2429
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2132633210
- Cited by
- 363
- References
- 24
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 1 · 2022: 1 · 2021: 7 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 5 · 2015: 9 · 2014: 10 · 2013: 14 · 2012: 11
- FWCI
- 9.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- candidemia, amphotericin B, fluconazole, mortality, catheter-related candidemia, catheter removal, antifungal therapy, adverse drug reactions
- MeSH terms
- Aged, Amphotericin B, Antifungal Agents, Candidiasis, Catheters, Indwelling, Humans, Middle Aged, Prospective Studies, Risk Factors, Fluconazole, Fungemia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
