632. Pattern of Candidemia Therapy Modification From Treatment Onset: An Evaluation of Daily Changes by Regimen and Species
Session: Abstracts: Mycology
Friday, October 22, 2010

Background: We evaluated the frequency of changes from initial antifungal therapy in critically ill patients with candidemia.

Methods: A cohort of critically ill patients from the Prospective Antifungal Therapy (PATH) Alliance registry, as identified by requirement for mechanical ventilation, who were initially treated for candidemia with either fluconazole or an echinocandin.

Results: Of 689 patients eligible for analysis, 374 (54%) were treated initially with fluconazole and 315 (46%) with an echinocandin. The drug initially prescribed for candidemia was more frequently either changed or supplemented within two days among fluconazole than echinocandin patients (90 [24%] and 35 [11%] patients respectively, P<0.001), but within six days of starting therapy changes or supplementation rates were almost identical (Figures below).

 

Conclusion: Among ventilated patients with candidemia, changes to initial fluconazole treatment occurred most commonly one day after identification of candidemia, and on that day almost equally among patients infected with any species other than albicans, suggesting that early results of testing for albicans infection motivated the change. In contrast, changes to initial echinocandin regimens typically were made three to four days after identification of candidemia, and for cases where glabrata and krusei were not isolated.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Daniel H. Kett, MD , Division of Pulmonary and Critical Care Medicine, The Miller School of Medicine at the University of Miami, Miami, FL
Marcela A. Ferrada, M.D. , Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
Andrew A. Quartin, M.D., M.P.H. , Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
Michele Morris, MD, FIDSA , Infectious Diseases, University of Miami/Jackson Memorial Hospital, Miami, FL

Disclosures:

D. H. Kett, Yes
Pfizer: Consultant, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium
Astellas: Consultant, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium
Merck: Investigator, Research support

M. A. Ferrada, None

A. A. Quartin, None

M. Morris, Yes
Astellas: Investigator, NA, Scientific Advisor and Speaker's Bureau,
Pfizer: Consultant, Investigator, NA, Scientific Advisor and Speaker's Bureau,
Merck: Consultant, NA, Research Contractor and Speaker's Bureau,

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