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Therapeutic Approaches in Patients With Candidemia: Evaluation in a Multicenter, Prospective, Observational Study

Therapeutic Approaches in Patients With Candidemia: Evaluation in a Multicenter, Prospective,... 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 ≤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.(Arch Intern Med. 1995;155:2429-2435) References 1. Dyess DL, Garrison N, Fry DE. Candida sepsis. Arch Surg . 1985;120:345-348.Crossref 2. Horn R, Hong B, Kiehn TE, Armstrong D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Clin Infect Dis . 1985;7: 646-655.Crossref 3. Komshian SV, Uwaydah AK, Sobel JD, Crane LF. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Clin Infect Dis . 1989; 3:379-390.Crossref 4. Edwards JR Jr. Invasive Candida infections: evolution of a fungal pathogen. N Engl J Med . 1991;324:1060-1062.Crossref 5. Medoff G, Dismukes WE, Meade RH III, Moses JM. A new therapeutic approach to Candida infections. Arch Intern Med . 1972;130:241-245.Crossref 6. Anaissie E, Bodey GP, Kantarjian H, et al. Fluconazole therapy for chronic disseminated candidiasis in patients with leukemia and prior amphotericin B therapy. Am J Med . 1991;91:142-150.Crossref 7. Kauffman CA, Bradley SF, Ross SC, Weber DR. Hepatosplenic candidiasis: successful treatment with fluconazole. Am J Med . 1991;91:137-141.Crossref 8. Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. N Engl J Med . 1994;331:1325-1330.Crossref 9. Hilf M, Yu VL, Sharp J, Zuravleff JJ, Korvick JA, Muder RR. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am J Med . 1989;87:540-546.Crossref 10. Chow JW, Fine MJ, Shlaes DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med . 1991;115:585-590.Crossref 11. Korvick JA, Bryan CS, Farber B, et al. Prospective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations vs monotherapy. Antimicrob Agents Chemother . 1992;36:2639-2644.Crossref 12. Miller PJ, Wenzel RP. Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections. J Infect Dis . 1987;156: 471-477.Crossref 13. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med . 1988;148:2642-2645.Crossref 14. Meunier-Carpentier F, Kiehn TE, Armstrong D. Fungemia in the immunocompromised host: changing patterns, antigenemia, high mortality. Am J Med . 1981; 71:363-370.Crossref 15. Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis . 1992;15:414-421.Crossref 16. Donahue SP, Greven C, Zuravleff JJ, et al. Ocular candidiasis in candidemic patients: clinical implications derived from a prospective multicenter study. Ophthalmology . 1994;101:1302-1309.Crossref 17. Eppes SC, Troutman JL, Gutman LT. Outcome of treatment of candidemia in children whose central catheters were removed or retained. Pediatr Infect Dis J . 1989;8:99-104.Crossref 18. Dato VM, Dajani AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy. Pediatr Infect Dis J . 1990; 9:309-314.Crossref 19. Lecciones JA, Lee JW, Navarro EE, et al. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis . 1992; 14:875-883.Crossref 20. Solomkin JS, Flohr A, Simmons RL. Candida infections in surgical patients. Ann Surg . 1982;195:177-185.Crossref 21. Bryce EA, Roberts FJ, Sekhon AS, Coldman AJ. Yeast in blood cultures: evaluation of factors influencing outcome. Diagn Microbiol Infect Dis . 1992;15:233-237.Crossref 22. Nolla-Salas J, Leon C, Torres-Rodriguez JM, Martin E, Sitges-Serra A. Treatment of candidemia in critically ill patients with intravenous fluconazole. Clin Infect Dis . 1992;14:952-954.Crossref 23. Graninger W, Presteril E, Schneeweiss B, Teleky B. Georgopoulos A. Treatment of Candida albicans fungaemia with fluconazole. J Infect . 1993;26:133-146.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Therapeutic Approaches in Patients With Candidemia: Evaluation in a Multicenter, Prospective, Observational Study

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References (32)

Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430220087009
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Abstract

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 ≤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.(Arch Intern Med. 1995;155:2429-2435) References 1. Dyess DL, Garrison N, Fry DE. Candida sepsis. Arch Surg . 1985;120:345-348.Crossref 2. Horn R, Hong B, Kiehn TE, Armstrong D. Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy. Clin Infect Dis . 1985;7: 646-655.Crossref 3. Komshian SV, Uwaydah AK, Sobel JD, Crane LF. Fungemia caused by Candida species and Torulopsis glabrata in the hospitalized patient: frequency, characteristics, and evaluation of factors influencing outcome. Clin Infect Dis . 1989; 3:379-390.Crossref 4. Edwards JR Jr. Invasive Candida infections: evolution of a fungal pathogen. N Engl J Med . 1991;324:1060-1062.Crossref 5. Medoff G, Dismukes WE, Meade RH III, Moses JM. A new therapeutic approach to Candida infections. Arch Intern Med . 1972;130:241-245.Crossref 6. Anaissie E, Bodey GP, Kantarjian H, et al. Fluconazole therapy for chronic disseminated candidiasis in patients with leukemia and prior amphotericin B therapy. Am J Med . 1991;91:142-150.Crossref 7. Kauffman CA, Bradley SF, Ross SC, Weber DR. Hepatosplenic candidiasis: successful treatment with fluconazole. Am J Med . 1991;91:137-141.Crossref 8. Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. N Engl J Med . 1994;331:1325-1330.Crossref 9. Hilf M, Yu VL, Sharp J, Zuravleff JJ, Korvick JA, Muder RR. Antibiotic therapy for Pseudomonas aeruginosa bacteremia: outcome correlations in a prospective study of 200 patients. Am J Med . 1989;87:540-546.Crossref 10. Chow JW, Fine MJ, Shlaes DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med . 1991;115:585-590.Crossref 11. Korvick JA, Bryan CS, Farber B, et al. Prospective observational study of Klebsiella bacteremia in 230 patients: outcome for antibiotic combinations vs monotherapy. Antimicrob Agents Chemother . 1992;36:2639-2644.Crossref 12. Miller PJ, Wenzel RP. Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections. J Infect Dis . 1987;156: 471-477.Crossref 13. Wey SB, Mori M, Pfaller MA, Woolson RF, Wenzel RP. Hospital-acquired candidemia: the attributable mortality and excess length of stay. Arch Intern Med . 1988;148:2642-2645.Crossref 14. Meunier-Carpentier F, Kiehn TE, Armstrong D. Fungemia in the immunocompromised host: changing patterns, antigenemia, high mortality. Am J Med . 1981; 71:363-370.Crossref 15. Fraser VJ, Jones M, Dunkel J, Storfer S, Medoff G, Dunagan WC. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis . 1992;15:414-421.Crossref 16. Donahue SP, Greven C, Zuravleff JJ, et al. Ocular candidiasis in candidemic patients: clinical implications derived from a prospective multicenter study. Ophthalmology . 1994;101:1302-1309.Crossref 17. Eppes SC, Troutman JL, Gutman LT. Outcome of treatment of candidemia in children whose central catheters were removed or retained. Pediatr Infect Dis J . 1989;8:99-104.Crossref 18. Dato VM, Dajani AS. Candidemia in children with central venous catheters: role of catheter removal and amphotericin B therapy. Pediatr Infect Dis J . 1990; 9:309-314.Crossref 19. Lecciones JA, Lee JW, Navarro EE, et al. Vascular catheter-associated fungemia in patients with cancer: analysis of 155 episodes. Clin Infect Dis . 1992; 14:875-883.Crossref 20. Solomkin JS, Flohr A, Simmons RL. Candida infections in surgical patients. Ann Surg . 1982;195:177-185.Crossref 21. Bryce EA, Roberts FJ, Sekhon AS, Coldman AJ. Yeast in blood cultures: evaluation of factors influencing outcome. Diagn Microbiol Infect Dis . 1992;15:233-237.Crossref 22. Nolla-Salas J, Leon C, Torres-Rodriguez JM, Martin E, Sitges-Serra A. Treatment of candidemia in critically ill patients with intravenous fluconazole. Clin Infect Dis . 1992;14:952-954.Crossref 23. Graninger W, Presteril E, Schneeweiss B, Teleky B. Georgopoulos A. Treatment of Candida albicans fungaemia with fluconazole. J Infect . 1993;26:133-146.Crossref

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Archives of Internal Medicine – American Medical Association

Published: Dec 11, 1995

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