Impact of empirical treatment with antifungal agents on survival of patients with candidemia / Impacto del tratamiento antifúngico empírico en la supervivencia de pacientes con candidemia

ABSTRACT

Introduction: The objective of this study was to evaluate the impact of echinocandins and fluconazole) on mortality 7 and 30 days after candidemia onset and overall in-hospital mortality), in patients with candidemia at a Spanish tertiary hospital. Methods: A retrospective study was conducted that enrolled all non-neutropenic adult patients diagnosed with candidemia at Hospital Clínico Universitario de Valladolid between 2007 and 2016. A total of 179 patients were evaluated, they were divided into two sub-groups surviving patients (n = 92) and non-surviving patients (n = 87). Results: The 7-day mortality was 25,1% (45), 30-day mortality was 46,9% (84), and overall in-hospital mortality was 48,6% (87). 40.8% of patients received no antifungal treatment (43.8% of surviving patients and 37.8% of non-surviving patients; p=0.15). A total of 106 (59.2%) patients were treated, of which 90 patients (50.3%) received empiric treatment. 19.6% and 47.8% of surviving patients were treated with echinocandins and fluconazole, respectively. By contrast, of non-surviving patients, 31.0% were treated with echinocandins and 47.1% received fluconazole. Survival for the first 7 days was significantly higher in treated with antifungal agents (log-rank = 0.029), however, there were not significant differences in 30-day survival. Factors linked to a significant increase in overall in-hospital mortality were age (OR 1.040), septic shock (OR 2.694) and need for mechanical ventilation > 48 h (OR 2.812). Conclusion: Patients who received antifungal treatment, regardless of whether they received fluconazole or echinocandins, had a significantly lower mortality rate after 7 days than untreated patients, although no significant differences in 30-day mortality were seen

RESUMEN

Introducción: El objetivo del estudio es evaluar el impacto del tratamiento antifúngico en la mortalidad hospitalaria a los 7 y 30 días en pacientes con candidemia en un hospital terciario español. Métodos: Se realizó un estudio retrospectivo que incluyó los pacientes adultos no neutropénicos diagnosticados de candidemia en el Hospital Clínico Universitario entre 2007 y 2016. Se evaluaron 179 pacientes, se dividieron en grupo de supervivientes (n=92) y no supervivientes (n=87). Resultados: La mortalidad a 7 días fue 25,1% (45), a los 30 días 46,9% (84) y la hospitalaria 48,6% (87). El 40,8% no recibieron antifúngico (43,8% de supervivientes y 37,8% de no supervivientes; p=0,15). El 50,3% (90) recibieron tratamiento empírico. De los supervivientes el 19,6% y 47,8% se trataron con equinocandinas y fluconazol, respectivamente. De los no supervivientes el 31% recibió equinocandinas y el 47,1% fluconazol. La supervivencia a los 7 días fue significativamente mayor en los tratados (log-rank = 0.029), no hubo diferencias a los 30 días. Los factores asociados a mortalidad hospitalaria fueron edad (OR 1.040), shock séptico (OR 2.694) y ventilación mecánica> 48 h (OR 2.812). Conclusión: Los pacientes tratados con antifúngicos (ya sean equinocandinas o fluconazol) tienen una tasa de mortalidad inferior a los 7 días que los no tratados, sin embargo no hallamos diferencias a los 30 días