Abstract
BackgroundThe 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.MethodsFrom 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.ResultsOne 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).ConclusionsAppropriate 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.
Highlights
The mortality of Candida Bloodstream Infection (CBSI) remains high
The Clinical and Laboratory Standards Institute (CLSI) recently defined new clinical breakpoints (CBP) for the most common Candida species to categorize them into resistant, intermediate and susceptible and guide antifungal therapy, these breakpoints are drug and species specific [6]. The rationale for these modifications was the relationship between a higher minimal inhibitory concentration (MIC) and worse outcome showed in some studies, epidemiologic cutoffs values, and pharmacokinetic/pharmacodynamic studies [7]
At the time of CBSI diagnosis, 25% (37/149) of the patients were admitted to intensive care unit (ICU), and 75% (112/149) were admitted to medical or surgical wards
Summary
Antifungal susceptibility breakpoints were recently updated for Candida species, the impact remains unknown. The Clinical and Laboratory Standards Institute (CLSI) recently defined new clinical breakpoints (CBP) for the most common Candida species to categorize them into resistant, intermediate and susceptible and guide antifungal therapy, these breakpoints are drug and species specific [6]. The rationale for these modifications was the relationship between a higher minimal inhibitory concentration (MIC) and worse outcome showed in some studies, epidemiologic cutoffs values, and pharmacokinetic/pharmacodynamic studies [7]. Antifungal susceptibility testing by automatized systems is considered reliable and may be more incorporated into routine clinical care [8,9,10]
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