The effect of time to antifungal therapy on mortality in candidemia associated septic shock
Abstract
The timely administration of appropriate antifungal therapy for Candida bloodstream infections (CBSI) improves clinical outcomes. However, little data exist on the effect of antifungal therapy in patients with septic shock and candidemia. We describe antifungal treatment of patients with septic shock due to CBSI and its impact on in-hospital mortality. We retrospectively reviewed medical records of hospitalized patients identified with at least one positive blood culture for Candida between January 2003 and June 2007. All septic shock patients received vasopressor therapy and had candidemia within 72 hours of refractory shock. Data collected included demographics, comorbidities, antibiotic exposure, in-hospital mortality, and intensive care-related factors. Acute Physiology and Chronic Health Evaluation II scores were calculated. Time to antifungal therapy was defined as the interval between time of collection of the first positive Candida blood culture and the time when appropriate antifungal therapy was initiated. Univariate and multivariate analyses were performed to identify variables associated with in-patient mortality. Classification and regression tree analysis was used to identify the mortality breakpoint between early and late antifungal therapy. Septic shock developed in 23% (31 of 135) patients with CBSI. In-hospital mortality was 68%. Nonalbicans Candida spp. accounted for 48% of blood isolates. Appropriate antifungal therapy was administered to 24 patients; 15 (63%) of these patients died. Classification and regression tree analysis revealed that patients who received appropriate antifungal therapy within 15 hours of collecting the first positive Candida blood culture had improved survival (P = 0.03). Early, appropriate antifungal therapy improves survival among patients with septic shock due to CBSI.
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In a retrospective review of Candida sepsis cases, patients who received early appropriate antifungal therapy within 15 hours of collecting the first positive blood culture had improved survival.
“Using classification and regression tree analysis (CART), they found patients who received early, appropriate antifungal therapy (within 15 hours of collecting the first positive blood culture) had improved survival.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [48]
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Kumar, A. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr090 · Cited by 92 · see citing works
Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting
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- Authors
- Patel, G. P., Simon, D., Scheetz, M., Crank, C. W., Lodise, T., & Patel, N.
- Affiliations
- Rush University Medical Center (US)
- Midwestern University (US)
- Albany College of Pharmacy and Health Sciences (US)
- Corresponding author
- Patel, Gourang P
- Venue
- American Journal of Therapeutics
- Published
- 2009-11
- Volume
- 16
- Issue
- 6
- Pages
- 508-511
- ISSN
- 1075-2765 (ISSN-L)
- OpenAlex
- W1979106685
- Cited by
- 92
- References
- 13
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 6 · 2018: 8 · 2017: 3 · 2016: 2 · 2015: 6 · 2014: 6 · 2013: 4 · 2012: 5
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- candidemia, septic shock, antifungal therapy timing, in-hospital mortality, vasopressor therapy, classification and regression trees
- MeSH terms
- Antifungal Agents, Candidiasis, Drug Administration Schedule, Female, Humans, Inpatients, Male, Middle Aged, Retrospective Studies, Risk Factors, Shock, Septic, Time Factors, Survival Rate, Hospital Mortality
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