Impact of inappropriate antifungal therapy according to current susceptibility breakpoints on Candida bloodstream infection mortality, a retrospective analysis
Por:
González-Lara M.F., Torres-González P., Cornejo-Juárez P., Velázquez-Acosta C., Martinez-Gamboa A., Rangel-Cordero A., Bobadilla-Del-Valle M., Ostrosky-Zeichner L., Ponce-de-León A., Sifuentes-Osornio J.
Publicada:
1 ene 2017
Categoría:
Infectious diseases
Resumen:
RESULTS: One hundred forty-nine episodes of CBSI were analyzed. The most frequent species were: C. albicans (40%), C. tropicalis (23%) and C. glabrata complex (20%). According to the 2012 CLSI, 10.7% received inappropriate treatment. The 30-day mortality was 38%; severe sepsis [Odds ratio (OR) 3.4; 95% CI 1.3-8.4], cirrhosis (OR 36; 95% CI 12.2-605), early central venous catheter removal (OR 0.23; 95% CI 0.08-0.66) and previous antifungal therapy (OR 0.15; 95%CI 0.03-0.62), were associated with 30-day mortality by multivariate analysis. Inappropriate antifungal treatment was not (OR 0.19; 95% CI 0.03-1.2).BACKGROUND: The mortality of Candida Bloodstream Infection (CBSI) remains high. Antifungal susceptibility breakpoints were recently updated for Candida species, the impact remains unknown. In this study we evaluated the impact of inappropriate antifungal treatment according to recent breakpoints on 30-day mortality of CBSI.METHODS: From June 2008 to July 2014, data on CBSI episodes from two tertiary-care centers, treated > 72 h were analyzed. Antifungal therapy and 30-day mortality were registered. Inappropriate antifungal treatment according to current Clinical & Laboratory Standards Institute (CLSI) breakpoints was adjusted with 30-day mortality-related co-variates.CONCLUSIONS: Appropriate antifungal therapy according to CLSI 2012 did not have an impact on mortality. Mortality of CBSI remains high due to disease severity and comorbidities; early antifungal therapy and catheter removal may reduce it.
Filiaciones:
González-Lara M.F.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Torres-González P.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Cornejo-Juárez P.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Velázquez-Acosta C.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Martinez-Gamboa A.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Rangel-Cordero A.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Bobadilla-Del-Valle M.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Ostrosky-Zeichner L.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Ponce-de-León A.:
Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Belisario Domínguez Sección XVI, Mexico City, Vasco de Quiroga 15, Code, TX Zip14080, Mexico
Sifuentes-Osornio J.:
Department of Infectious Diseases, Instituto Nacional de Cancerología, Belisario Dominguez Sección XVI, Mexico City, Ave. San Fernando 22, code, TX Zip14080, Mexico
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