Program Schedule

Review of Empiric Echinocandin Therapy for Candidemia

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • CRISTINA_POSTER FINAL.pdf (320.9 kB)
  • Background: Candidemia represents up to 9% of all blood cultures, of which the majority are due to azole-sensitive species.  The 2009 IDSA guidelines recommend empirically starting fluconazole ($7/day at 2013 GW hospital pharmacy pricing) for candidemia until species identification.   The exceptions are for patients with moderately severe to severe illness, patients who are neutropenic, or patients with recent azole exposure.  In clinical practice however, echinocandins ($117/day) are started empirically in the majority of patients with candidemia without clear benefit, but at significantly increased financial burden. 

    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.

    Cristina Amado, MD, Infectious Diseases, George Washington University, Alexandria, VA, Paul Blair, MD, Internal Medicine, George Washington University, Washington, DC, Marc Siegel, MD, Medicine, Medical Faculty Associates/George Washington University Medical Center, Washington, DC and John Keiser, MD, George Washington University Hospital, Washington, DC


    C. Amado, None

    P. Blair, None

    M. Siegel, None

    J. Keiser, None

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