Review of Empiric Echinocandin Therapy for Candidemia
Methods: We reviewed the hospital records of any patient at the George Washington University Hospital with candidemia over a 6-year period from 1/1/2008 through 12/31/2013, and evaluated the empiric antifungal therapy used in relation to the Candida species and patient clinical status. Fluconazole sensitivity was routinely tested for all Candida species after 1/1/2011.
Results: 163 patients (97 men, 66 women) with a mean age of 58 years old had 411 positive blood cultures for Candida, of which 74.8% were hospital-acquired. 51.5% of patients were in the ICU and 83.4% had a central venous catheter at the time of their candidemia. Infectious Diseases consultation was requested in 70.2% of cases and the 30-day mortality was 39.3%. C. albicans accounted for the majority of episodes (34.7%), followed by C. parapsilosis (30%), C.glabrata (19.5%), and C. krusei (3%). 46.8% of the C. glabrata isolates after 1/1/2011 were azole-resistant, but accounted for only 10.4% of all candidemias over this time period. An echinocandin was started empirically in 70.9% of cases, but was switched over to fluconazole in 51.9% of these cases. No ID consult was obtained in 56 episodes of candidemia and in 19 (33.9%), of these an echinocandin was the sole therapy used for azole-sensitive Candida species. This occurred only in 15.9% of cases when an ID consult was requested, which was statistically significant.
Conclusion: Echinocandins are used as empiric therapy for candidemia in the majority of patients despite a low prevalence of azole-resistant Candida species resulting in significantly increased cost despite no definitive mortality benefit.
M. Siegel, None
J. Keiser, None