893. Initial Treatment Patterns and Antifungal Switching in Hospitalized Patients with Candidemia
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Guideline-recommended initial treatment of candidemia includes fluconazole or an echinocandin, depending on the severity of illness, recent azole exposure, identification of Candida species, and other factors. The patterns of initial antifungal (AF) treatment and switching to other agents have not been well established. This observational study describes initial AF and treatment switching patterns in patients with Candida infections, and explores these patterns by Candida species.

Methods: A retrospective analysis (2005-2010) of the Health Facts® database (Cerner Corp., Kansas City, MO), containing comprehensive clinical records from 141 US hospitals identified patients aged ≥ 18 with a blood culture positive for Candida and no other fungus. An AF switch was defined as the first change in the agent or route of administration. Patients with combination AF therapy (concurrent therapy > 48 hours) were excluded. Univariate analyses were performed.

Results: 1,652 inpatients with candidemia were identified. Mean age was 62 years and 51.8% were male, and 31.1% died. Fewer than 25% had an ICD-9-CM diagnosis of invasive candidiasis (8.4% in patients with no AF treatment). Initial AF treatment was fluconazole (49%), an echinocandin (27%), no AF (22%), an amphotericin B agent (1.4%), or another azole (1.6%). A switch occurred in 649 (39%) of patients; 75% of the switches were to a different AF class. More than half (52%) of the 802 initial fluconazole patients switched; of those, 244 (58%) switched to an echinocandin. Of 443 initial echinocandin patients, 44% switched and most of those switches (80%) were to fluconazole. The most common species identified were Candida albicans (49%), C. glabrata (32%), C. parapsilosis (14%), C. tropicalis (7%) and C. krusei (2%). Species identification may have influenced switching among initial fluconazole and echinocandin patients.

Conclusion: In a large multihospital database, switching among fluconazole and echinocandins is common. Current treatment patterns raise concerns regarding initial treatment strategies for management of serious and commonly fatal inpatient Candida infections.


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

Rolin Wade, RPh, MS1, Paresh Chaudhari, PharmD2, Rebecca Campbell, MD, MPH1, Harlen Hays, MPH1, Jing Yi, MA1, Smita Kothari, PhD, MBA, RPh2 and David Horn, MD3, (1)Cerner LifeSciences, Beverly Hills, CA, (2)Astellas Pharma US, Inc., Deerfield, IL, (3)David Horn, MD, Doylestown, PA

Disclosures:

R. Wade, Astellas Pharma, US: Consultant, Consulting fee
Cerner LifeSciences: Employee and Shareholder, Salary

P. Chaudhari, Astellas Pharma, US: Employee, Salary

R. Campbell, Astellas Pharma, US: Consultant, Consulting fee
Cerner LifeSciences: Employee and Shareholder, Salary

H. Hays, Astellas Pharma, US: Consultant, Consulting fee
Cerner LifeSciences: Employee and Shareholder, Salary

J. Yi, Astellas Pharma, US: Consultant, Consulting fee
Cerner LifeSciences: Employee and Shareholder, Salary

S. Kothari, Astellas Pharma, US: Employee, Salary

D. Horn, Astellas Pharma, US: Consultant, Consulting fee

See more of: Antifungal Therapy
See more of: Poster Abstract Session

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.