Initial use of echinocandins does not negatively influence outcome in Candida parapsilosis bloodstream infection: A propensity score analysis
Abstract
BACKGROUND: Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins. METHODS: The Prospective Population Study on Candidemia in Spain (CANDIPOP) is a prospective multicenter, population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing, and antifungal susceptibility testing was performed by the European Committee on Antimicrobial Susceptibility Testing methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analyzed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach. RESULTS: Among 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58 of 177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio [AOR], 2.81; P = .018) and septic shock (AOR, 2.91; P = .081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (AOR, 0.43; P = .040). Neither univariate nor multivariate analysis revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding. CONCLUSIONS: The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.
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Observational clinical data did not show an association between echinocandin treatment of C. parapsilosis bloodstream and treatment failure.
“In contrast, observational clinical data did not show an association between echinocandin treatment of C. parapsilosis bloodstream and treatment failure [88].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [88]
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- Authors
- Fernández-Ruiz, M., Aguado, J. M., Almirante, B., Lora-Pablos, D., Padilla, B., Puig-Asensio, M., Montejo, M., García-Rodríguez, J., Pemán, J., Ruiz Pérez de Pipaón, M., Cuenca-Estrella, M., Padilla, B., Muñoz, P., Guinea, J., Paño Pardo, J. R., García-Rodríguez, J., Cerrada, C. G., Fortún, J., Martín, P., Gómez, E., Ryan, P., Campelo, C., de los Santos Gil, I., Buendía, V., Gorricho, B. P., Alonso, M., Sanz, F. S., Aguado, J. M., Merino, P., Romo, F. G., Gorgolas, M., Gadea, I., Losa, J. E., Delgado-Iribarren, A., Ramos, A., Romero, Y., Romero, I. S., Zaragoza, O., Cuenca-Estrella, M., Rodriguez-Baño, J., Suarez, A. I., Loza, A., Aller García, A. I., Martín-Mazuelos, E., de Pipaón, M. R. P., Garnacho, J., Ortiz, C., Chávez, M., Maroto, F. L., Salavert, M., Pemán, J., Blanquer, J., Navarro, D., Camarena, J. J., Zaragoza, R., Abril, V., Gimeno, C., Hernáez, S., Ezpeleta, G., Bereciartua, E., Hernández Almaraz, J. L., Montejo, M., Rivas, R. A., Ayarza, R., Ma Planes, A., Ruiz Camps, I., Almirante, B., Mensa, J., Almela, M., Gurgui, M., Sánchez-Reus, F., Martinez-Montauti, J., Sierra, M., Horcajada, J. P., Sorli, L., Gómez, J., Gené, A., Urrea, M., Valerio, M., Díaz-Martín, A., Puchades, F., & Mularoni, A.
- Affiliations
- Research Institute Hospital 12 de Octubre (ES)
- Hospital de Cruces (ES)
- Universitat Autònoma de Barcelona (ES)
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-03-18
- Volume
- 58
- Issue
- 10
- Pages
- 1413-1421
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2098810355
- Cited by
- 122
- References
- 40
- Citations by year
- 2026: 1 · 2025: 7 · 2024: 3 · 2023: 9 · 2022: 9 · 2021: 8 · 2020: 15 · 2019: 8 · 2018: 15 · 2017: 18 · 2016: 15 · 2015: 9 · 2014: 4
- FWCI
- 10.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Styrelsen för Internationellt Utvecklingssamarbete
- Gilead Sciences
- Fundación Mutua Madrileña
- European Commission
- Ministerio de Economía y Competitividad (RD12/0015, REIPI RD12/0015)
- Astellas Pharma
- Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
- Grupo Ferrer Internacional, S.A
- Pan American Health Organization
- Instituto de Salud Carlos III (REIPI RD12/0015, RD12/0015)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- Candida parapsilosis, bloodstream infection, echinocandins, antifungal therapy, clinical failure, mortality, persistent candidemia, septic shock, orotracheal intubation, central venous catheter removal, antifungal susceptibility
- MeSH terms
- Adult, Aged, Antifungal Agents, Candida, Female, Humans, Infant, Male, Microbial Sensitivity Tests, Middle Aged, Population Surveillance, Prospective Studies, Risk Factors, Spain, Treatment Outcome, Sequence Analysis, DNA, Drug Resistance, Fungal, Echinocandins, Propensity Score, Candidemia
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