897. Assessment of the Influence of Timing of Antifungal (AF) Therapy on Outcomes in Candidemia
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • idsaposter-candidemia-TLE.pdf (125.1 kB)
  • Background: Candidemia is an increasingly common condition for which AF therapy is often delayed. We evaluated the relationship between timely administration of AF therapy and candidemia-attributable mortality.

    Methods: This was a retrospective cohort study of patients >18 years old with candidemia treated with AF therapy from 2003-2010.  Patients with a hospital stay <48 hours; or who received AF therapy in the past 30 days were excluded.  The primary outcome was candidemia-attributable mortality.  Time to initiation of AF therapy was defined as collection of first positive blood culture for Candida species to the start of AF therapy.  Inappropriate therapy was defined as the use of fluconazole for the treatment of C. krusei or doses of fluconazole <800 mg per day for C. glabrata.

    Results: A total of 186 patients met inclusion criteria (56.5% male, mean age 56.4 + 17.3 years, 6.5% immunocompromised).  Candidemia species included C. albicans, lusitaniae, parapsilosis, tropicalis (131 patients [70.4%]) or C. glabrata and krusei (55 patients [29.6%]).  Initial AF agents selected were fluconazole (90 patients [48.4%]) and an echinocandin (96 patients [51.6%]), with 145 patients (77.8%) receiving appropriate initial AF therapy.  By the univariate analysis, age (p<0.001), Charlson score (p=0.004), APACHE II score (p<0.001) prior antibiotic use (p=0.002), and initial AF agent used (p=0.008) were associated with mortality.  Time to AF therapy was not found to be a significant predictor of mortality in either univariate or multivariate analysis (p=0.18).  Interestingly, mortality rates were greatest in patients receiving AF therapy in <24 hours (8/20 patients [40%]) and >96 hours (15/38 patients [39.5%]).  Other mortality rates were: 24-48 hours (9/47 patients [19.2%]), 48-72 hours (23/60 patients [38.3%]), 72-96 hours (6/21 patients [28.6%]).  On multivariate analysis, only APACHE II score was found to be an independent predictor of mortality.

    Conclusion: In our study, time to appropriate AF therapy was not found to be a significant predictor of candidemia-attributable mortality.


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

    Thy Le, Pharm.D., Pharmacy, Temple University Hospital, Philadelphia, PA, Conan Macdougall, Pharm.D., MAS, BCPS, University of California San Francisco School of Pharmacy, San Francisco, CA and Jason Gallagher, Pharm.D., B.C.P.S., Temple University, Philadelphia, PA

    Disclosures:

    T. Le, None

    C. Macdougall, None

    J. Gallagher, Pfizer: Scientific Advisor, Consulting fee
    Merck: Grant Investigator, Grant recipient
    Astellas: Speaker's Bureau, Speaker honorarium

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