Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis
This study aimed to evaluate the effectiveness of fluconazole and echinocandins in the treatment of candidemia caused by both fluconazole- and echinocandin-susceptible common <i>Candida</i> species. A retrospective study which enrolled adult candidemia patients ≥19 years diagnosed at a t...
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| Format: | Article |
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MDPI AG
2023-05-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/9/5/539 |
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| author | Jong Hun Kim Jin Woong Suh Min Ja Kim |
| author_facet | Jong Hun Kim Jin Woong Suh Min Ja Kim |
| author_sort | Jong Hun Kim |
| collection | DOAJ |
| description | This study aimed to evaluate the effectiveness of fluconazole and echinocandins in the treatment of candidemia caused by both fluconazole- and echinocandin-susceptible common <i>Candida</i> species. A retrospective study which enrolled adult candidemia patients ≥19 years diagnosed at a tertiary care hospital in the Republic of Korea from 2013 to 2018 was conducted. Common <i>Candida</i> species were defined as <i>C. albicans</i>, <i>C. tropicalis</i>, and <i>C. parapsilosis</i>. Cases of candidemia were excluded based on the following exclusion criteria: (1) candidemia showed resistance to either fluconazole or echinocandins, or (2) candidemia was caused by other <i>Candida</i> species than common <i>Candida</i> species. In order to compare the mortality rates between patients who receive fluconazole or echinocandins, the propensity scores on variables of baseline characteristics using the multivariate logistic regression analysis were employed to balance the antifungal treatment groups, and a Kaplan–Meier survival analysis was performed. Fluconazole and echinocandins were used in 40 patients and in 87 patients, respectively. The propensity score matching included 40 patients in each treatment group. After matching, the rates of 60-day mortality after candidemia were 30% in the fluconazole group and 42.5% in the echinocandins group, and a Kaplan–Meier survival analysis showed no significant difference between antifungal treatment groups, <i>p</i> = 0.187. A multivariable analysis demonstrated that septic shock was significantly associated with the 60-day mortality, whereas fluconazole antifungal treatment was not associated with an excess 60-day mortality. In conclusion, our study results suggest that fluconazole use in the treatment of candidemia caused by susceptible common <i>Candida</i> species may be not associated with increased 60-day mortality compared to echinocandins. |
| first_indexed | 2024-03-11T03:35:08Z |
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| language | English |
| last_indexed | 2024-03-11T03:35:08Z |
| publishDate | 2023-05-01 |
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| spelling | doaj.art-16c6adb28e484170b59f3c30d56fc6cb2023-11-18T02:01:59ZengMDPI AGJournal of Fungi2309-608X2023-05-019553910.3390/jof9050539Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching AnalysisJong Hun Kim0Jin Woong Suh1Min Ja Kim2Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of KoreaDivision of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of KoreaDivision of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Republic of KoreaThis study aimed to evaluate the effectiveness of fluconazole and echinocandins in the treatment of candidemia caused by both fluconazole- and echinocandin-susceptible common <i>Candida</i> species. A retrospective study which enrolled adult candidemia patients ≥19 years diagnosed at a tertiary care hospital in the Republic of Korea from 2013 to 2018 was conducted. Common <i>Candida</i> species were defined as <i>C. albicans</i>, <i>C. tropicalis</i>, and <i>C. parapsilosis</i>. Cases of candidemia were excluded based on the following exclusion criteria: (1) candidemia showed resistance to either fluconazole or echinocandins, or (2) candidemia was caused by other <i>Candida</i> species than common <i>Candida</i> species. In order to compare the mortality rates between patients who receive fluconazole or echinocandins, the propensity scores on variables of baseline characteristics using the multivariate logistic regression analysis were employed to balance the antifungal treatment groups, and a Kaplan–Meier survival analysis was performed. Fluconazole and echinocandins were used in 40 patients and in 87 patients, respectively. The propensity score matching included 40 patients in each treatment group. After matching, the rates of 60-day mortality after candidemia were 30% in the fluconazole group and 42.5% in the echinocandins group, and a Kaplan–Meier survival analysis showed no significant difference between antifungal treatment groups, <i>p</i> = 0.187. A multivariable analysis demonstrated that septic shock was significantly associated with the 60-day mortality, whereas fluconazole antifungal treatment was not associated with an excess 60-day mortality. In conclusion, our study results suggest that fluconazole use in the treatment of candidemia caused by susceptible common <i>Candida</i> species may be not associated with increased 60-day mortality compared to echinocandins.https://www.mdpi.com/2309-608X/9/5/539candidemiafluconazoleechinocandinmortality |
| spellingShingle | Jong Hun Kim Jin Woong Suh Min Ja Kim Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis Journal of Fungi candidemia fluconazole echinocandin mortality |
| title | Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis |
| title_full | Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis |
| title_fullStr | Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis |
| title_full_unstemmed | Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis |
| title_short | Evaluation of Fluconazole versus Echinocandins for Treatment of Candidemia Caused by Susceptible Common <i>Candida</i> Species: A Propensity Score Matching Analysis |
| title_sort | evaluation of fluconazole versus echinocandins for treatment of candidemia caused by susceptible common i candida i species a propensity score matching analysis |
| topic | candidemia fluconazole echinocandin mortality |
| url | https://www.mdpi.com/2309-608X/9/5/539 |
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