Fernández-Ruiz M, Aguado JM, Almirante B, Lora-Pablos D, Padilla B, Puig-Asensio M, Montejo M, García-Rodríguez J, Pemán J, de Pipaón MR, Cuenca-Estrella M; on behalf of the CANDIPOP Project; GEIH-GEMICOMED (SEIMC) and REIPI.; Clin Infect Dis. 2014 Mar 18. [Epub ahead of print]
Background. Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins.
Methods. The CANDIPOP Study is a prospective multicenter population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing and antifungal susceptibility testing was performed by the EUCAST methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analysed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach.
Results. Out of 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58/177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio [aOR] 2.81; P-value=0.018) and septic shock (aOR 2.91; P-value=0.081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (aOR 0.43; P-value=0.040). Neither univariate nor multivariate revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding.
Conclusions. The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.