436: MICAFUNGIN VERSUS TRADITIONAL ANTIFUNGAL AGENTS FOR CANDIDA GLABRATA OR CANDIDA KRUSEI CANDIDURIA

Abstract

Introduction: Candida-associated urinary tract infections caused by fluconazole-resistant species are challenging to treat, as many active agents concentrate poorly in the urine. In case reports, micafungin has demonstrated efficacy for candiduria despite minimal urinary excretion. This study aimed to expand the evidence on echinocandin therapy for urinary tract infections by comparing resolution of candiduria in patients treated with micafungin versus traditional antifungal therapy. Methods: This study was a multi-center, retrospective cohort trial conducted from January 2015 until May 2021. Patients 18 years or older with a positive urine culture for Candida glabrata or krusei and treatment with micafungin, amphotericin B, or fluconazole were included. The primary outcome was a composite of clinical (symptom resolution or SOFA score less than 2 within 7 days) or microbiologic cure (absence of index organism on repeat culture or urinalysis within 28 days). Results: A total of 56 patients were included in the final analysis. Treatment with micafungin, compared to traditional therapy, resulted in a higher attainment of the primary outcome of microbiologic or clinical cure (63.4% vs. 26.7%, p = 0.018). No significant difference was noted for the individual components of the composite, though each component numerically favored the micafungin group. Conclusions: Among patients with candiduria due to Candida glabrata or krusei, treatment with micafungin, compared to traditional antifungal therapies, was associated with a significantly higher attainment of the primary outcome of microbiologic or clinical cure. These results build upon previous literature supporting possible utility for micafungin in treating candiduria due to fluconazole-resistant organisms.