Factors related to survival and treatment success in invasive candidiasis or candidemia: a pooled analysis of two large, prospective, micafungin trials
Abstract
Crude and attributable mortality rates in patients with candidemia and invasive candidiasis remain unacceptably high. It is important to reach a more complete understanding of the risk factors underlying poor outcomes in patients with invasive Candida infections. Micafungin therapy has been assessed in two phase 3 trials compared to either liposomal amphotericin B or caspofungin. The availability of this large dataset allows the analyses of non-drug factors associated with survival and treatment success. A multivariate regression analysis was performed on data from the two trials separately and as a pooled analysis (N = 1,070). Analysis outcomes were survival at 42 days post-initiation of therapy and treatment success. For the pooled analysis, treatment success was significantly more likely for candidemia than invasive candidiasis. Both survival and treatment success were significantly less likely for the non-removal of catheter versus removal, Asian-Indians versus Caucasians, APACHE II score >20 to <or=30 and >30 versus <or=20, age >or=70 years versus <50 years, baseline corticosteroids, and persistent neutropenia. Survival was also significantly less likely for treatment in other regions versus North America and for patients with renal failure at baseline. These findings help to define non-antifungal drug factors that may impact survival and treatment success in invasive candidiasis or candidemia.
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Horn and colleagues used the same 2 phase III datasets and found that catheter retention was associated with poorer outcomes than patients who had it removed.
“Horn and colleagues 178 used the same 2 phase III datasets and found that catheter retention was associated with poorer outcomes than patients who had it removed.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [178]
Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (i.e., Candida) based on evidence from large retrospective and observational studies.
“Venous catheter infection and IC guidelines, including the current IDSA guidelines, recommend removal of any intravascular catheter that is positive for a fungal pathogen (ie, Candida) based on evidence from large retrospective and observational studies.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [178]
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References 32 · Cited by 69
- Authors
- Horn, D. L., Ostrosky-Zeichner, L., Morris, M. I., Ullmann, A. J., Wu, C., Buell, D. N., Kovanda, L. L., & Cornely, O. A.
- Affiliations
- Thomas Jefferson University (US)
- University of Miami (US)
- Johannes Gutenberg University Mainz (DE)
- Astellas Pharma (United States) (US)
- University of Cologne (DE)
- Corresponding author
- Horn, D. L.
- Venue
- European Journal of Clinical Microbiology & Infectious Diseases
- Published
- 2009-12-15
- Volume
- 29
- Issue
- 2
- Pages
- 223-229
- ISSN
- 0934-9723 (ISSN-L)
- 1435-4373
- OpenAlex
- W1982722510
- Cited by
- 69
- References
- 32
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 5 · 2017: 6 · 2016: 4 · 2015: 7 · 2014: 1 · 2013: 7 · 2012: 10
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Clinical Microbiology & Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Astellas Foundation for Research on Metabolic Disorders
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Keywords
- invasive candidiasis, candidemia, micafungin, survival, treatment success, risk factors, catheter removal, APACHE II score, corticosteroids, neutropenia, renal failure, regional variation, Indian patients, liposomal amphotericin B, caspofungin
- MeSH terms
- Micafungin, Adolescent, Adult, Aged, Aged, 80 and over, Amphotericin B, Antifungal Agents, Candidiasis, Catheterization, Female, Humans, Male, Middle Aged, North America, Prospective Studies, Survival Analysis, Fungemia, Treatment Outcome, APACHE, Racial Groups, Echinocandins, Lipopeptides, Young Adult
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