Effect of antifungal therapy timing on mortality in cancer patients with candidemia
Open accessAbstract
Prior studies have shown that delays in treatment are associated with increased mortality in patients with candidemia. The purpose of this study was to measure three separate time periods comprising the diagnosis and treatment of candidemia and to determine which one(s) is associated with hospital mortality. Patients with blood cultures positive for Candida spp. were identified. Subjects were excluded if no antifungal therapy was given or if there was preexisting antifungal therapy. Collected data included the time from blood culture collection to positivity (incubation period), the time from blood culture positivity to provider notification (provider notification period), and the time from provider notification to the first dose of antifungal given (antifungal initiation period). These times were assessed as predictors of inpatient mortality. A repeat analysis was done with adjustments for age, sex, race, underlying cancer, catheter removal, APACHE III score, acute renal failure, neutropenia, and non- Candida albicans species. A total of 106 episodes of candidemia were analyzed. The median incubation time was 32.1 h and was associated with mortality (univariate hazard ratio per hour, 1.025; P = 0.001). The median provider notification and antifungal initiation periods were 0.3 and 7.5 h, respectively, and were not associated with mortality. Adjusted analysis yielded similar results. For cancer patients with candidemia, the incubation period accounts for a significant amount of time, compared with the provider notification and antifungal initiation times, and is associated with in-hospital mortality. Strategies to shorten the incubation time, such as utilizing rapid molecularly based diagnostic methods, may help reduce in-hospital mortality.
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In a cohort of patients with cancer, Taur and colleagues found similar results supporting early appropriate antifungal therapy.
“Another recent publication by Taur and colleagues 49 in a cohort of patients with cancer found similar results.”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [49]
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- Authors
- Taur, Y., Cohen, N., Dubnow, S., Paskovaty, A., & Seo, S. K.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Corresponding author
- Taur, Ying
- Venue
- Antimicrobial Agents and Chemotherapy
- Publisher
- American Society for Microbiology
- Published
- 2010-01
- Volume
- 54
- Issue
- 1
- Pages
- 184-190
- ISSN
- 0066-4804 (ISSN-L)
- 1098-6596
- PMC
- PMC2798557
- OpenAlex
- W2051757474
- Cited by
- 127
- References
- 49
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 5 · 2023: 5 · 2022: 9 · 2021: 6 · 2020: 6 · 2019: 5 · 2018: 3 · 2017: 8 · 2016: 7 · 2015: 10 · 2014: 13 · 2013: 15 · 2012: 11
- FWCI
- 5.98
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Antimicrobial Agents and Chemotherapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Keywords
- candidemia, antifungal therapy timing, in-hospital mortality, incubation period, cancer patients, Candida, rapid molecular diagnostics, neutropenia
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Antifungal Agents, Blood, Candidiasis, Child, Child, Preschool, Female, Humans, Infant, Male, Middle Aged, Neoplasms, Retrospective Studies, Cohort Studies, Multivariate Analysis, Hospital Mortality, APACHE, Young Adult, Acute Kidney Injury
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