886. Anidulafungin (ANI) for Candidemia/Invasive Candidiasis (C/IC) in Intensive Care Unit (ICU) Patients (Pts) Post-Abdominal Surgery (Sx)
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA Montravers et al Oct5 FINAL.pdf (151.5 kB)
  • Background: A recent study found ANI effective for C/IC in selected ICU populations. Since echinocandins have never been specifically evaluated for C/IC occurring post-abdominal Sx, we conducted a post hoc analysis from that study to compare the efficacy of ANI in pts with/without prior abdominal Sx.

    Methods: Prospective, open-label, multicenter study in adult ICU pts (APACHE II score <25) with documented C/IC and ≥1 of the following: post-abdominal Sx, ≥65 y, renal/hepatic insufficiency, solid organ transplant, neutropenia, and/or solid tumor. Pts received standard dose ANI for ≥10 days, followed by optional oral azoles, for a total of 14-56 days. The primary efficacy endpoint was global response at end of all therapy (EOT) in modified intent-to-treat (mITT) pts (≥1 dose of ANI and confirmed C/IC), excluding pts with missing/unknown responses. Pts were divided retrospectively into those with/without abdominal Sx prior to C/IC.

    Results: Among mITT pts, 90/170 underwent abdominal Sx. At baseline, these pts had a mean APACHE II score of 16.1 (range, 4-26) and mostly Candida albicans (57.8%), C glabrata (18.9%), C parapsilosis (6.7%), and C tropicalis (6.7%). The incidence of deep-tissue Candida infection at baseline was higher in pts with prior abdominal Sx (52.2%) than without (11.3%; P<0.01). Global responses were similar in pts with/without prior abdominal Sx throughout the study (Table). EOT global responses were similar in post-abdominal Sx pts with/without candidemia (67.5% and 69.2%, respectively, P=0.87) and those with/without C albicans (68.8% and 68.0%, respectively, P=0.95). Among post-abdominal Sx pts with ≥1 dose of ANI, treatment-related adverse events occurred in 12/113 (10.6%) pts; no single event occurred in >2 pts, and 2 events were serious.

    Conclusion: ANI appears to be a safe and effective therapy for C/IC post abdominal Sx.

     

    Patient population

    End of IV

     therapy

    n (%) [95% CI]

    EOT

     

    n (%) [95% CI]

    2 weeks

    post-EOT

    n (%) [95% CI]

    6 weeks

    post-EOT

    n (%) [95% CI]

    Post-abdominal Sx

    56/81 (69.1)

    [57.9-78.9]

    54/79 (68.4)

    [56.9-78.4]

    40/68 (58.8)

    [46.2-70.6]

    34/63 (54.0)

    [40.9-66.6]

    Without prior abdominal Sx

    55/76 (72.4)

    [60.9-82.0]

    53/75 (70.7)

    [59.0-80.6]

    37/60 (61.7)

    [48.2-73.9]

    21/46 (45.7)

    [30.9-61.0]

    P value for difference

    0.66

    0.76

    0.74

    0.39

     


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

    Philippe Montravers1, José Artur Paiva2, Wouter Meersseman3, Jan Pachl4, Ioana Grigoras5, Gabriele Sganga6, Francesco Menichetti7, Georgios Dimopoulos8, Georg Auzinger9, Marcio Borges Sá10, Paul Miller11, Tomás Marcek12, Michal Kantecki12 and Markus Ruhnke13, (1)CHU Bichat-Claude Bernard, Paris, France, (2)Hospital de Săo Joăo, Porto, Portugal, (3)University Hospital Leuven, Leuven, Belgium, (4)University Hospital Královské Vinohrady, Prague, Czech Republic, (5)University of Medicine and Pharmacy Iasi, Iasi, Romania, (6)Catholic University Hosp A. Gemelli Rome, Rome, Italy, (7)University Hospital Pisa, Pisa, Italy, (8)University Hospital , Athens, Greece, (9)King's College Hospital, London, United Kingdom, (10)Hospital Son Llatzer, Palma de Mallorca, Spain, (11)Pfizer Global Research and Development, Groton, CT, (12)Pfizer PIO, Paris, France, (13)Charité University Hospital, Berlin, Germany

    Disclosures:

    P. Montravers, Pfizer: Board Member, Investigator and Scientific Advisor, Consulting fee and Speaker honorarium
    Merck: Board Member, Investigator and Scientific Advisor, Consulting fee and Speaker honorarium
    Astellas: Board Member and Scientific Advisor, Consulting fee and Speaker honorarium

    J. A. Paiva, Pfizer: Investigator and Scientific Advisor, Consulting fee, Research support and Speaker honorarium
    Merck Sharp & Dohme: Investigator and Scientific Advisor, Consulting fee, Research support and Speaker honorarium
    Novartis: Investigator and Scientific Advisor, Consulting fee, Research support and Speaker honorarium

    W. Meersseman, Pfizer: Scientific Advisor, Research grant
    MSD: Speaker's Bureau, Educational grant

    J. Pachl, None

    I. Grigoras, Abbott: Investigator, Scientific Advisor and Speaker's Bureau, Speaker honorarium
    Astra: Investigator, Scientific Advisor and Speaker's Bureau, Speaker honorarium
    Bayer: Investigator, Scientific Advisor and Speaker's Bureau, Speaker honorarium
    Fresenius: Investigator, Scientific Advisor and Speaker's Bureau, Speaker honorarium
    Merck: Investigator, Scientific Advisor and Speaker's Bureau, Speaker honorarium
    Pfizer: Investigator, Scientific Advisor and Speaker's Bureau, Speaker honorarium

    G. Sganga, Pfizer: Scientific Advisor, Consulting fee and Speaker honorarium

    F. Menichetti, None

    G. Dimopoulos, Pfizer: Investigator and Scientific Advisor, Research grant and Speaker honorarium

    G. Auzinger, Pfizer: Investigator and Scientific Advisor, Consulting fee and Speaker honorarium

    M. Borges Sá, Pfizer: Investigator and Speaker's Bureau, Speaker honorarium
    Astellas: Speaker's Bureau, Speaker honorarium
    Astra-Zeneca: Speaker's Bureau, Speaker honorarium

    P. Miller, Pfizer: Employee and Shareholder, Salary

    T. Marcek, Pfizer: Employee, Salary

    M. Kantecki, Pfizer: Employee, Salary

    M. Ruhnke, Essex: Board Member and Speaker's Bureau, Consulting fee and Speaker honorarium
    MSD: Board Member, Investigator and Speaker's Bureau, Consulting fee, Research grant and Speaker honorarium
    Pfizer: Board Member, Investigator and Speaker's Bureau, Consulting fee, Educational grant, Research grant and Speaker honorarium
    Gilead: Board Member and Speaker's Bureau, Consulting fee and Speaker honorarium
    Astellas: Board Member and Speaker's Bureau, Consulting fee and Speaker honorarium
    Deutscher Stifterverband: Investigator, Grant recipient

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