217. MSG12: Comparative effectiveness of echinocandins vs. fluconazole therapy for the treatment of adult candidemia due to Candida parapsilosis
Session: Poster Abstract Session: Candida Infection
Thursday, October 8, 2015
Room: Poster Hall
Background: The 2009 Infectious Diseases Society of America (IDSA) guidelines for the treatment of Candida infections recommended fluconazole for Candida parapsilosis blood stream infections (BSI). Recent publications are conflicting regarding the role for echinocandins for C. parapsilosis BSI. A European cohort found that initial echinocandin therapy was not worse compared to fluconazole for patients with C. parapsilosis BSI. We aimed to compare the effectiveness of fluconazole vs. echinocandins for the management of C. parapsilosis BSI in a U.S. population.  

Methods: A cohort of adults >19 years of age was assembled using Premier PerspectiveTM Database, a large database of billing and culture data. All incident admissions between 2009 and 2013 inclusive of a C. parapsilosisBSI were included. A weighted logistic regression model was used to compare the 30-day mortality between patients receiving initial therapy with an echinocandin versus fluconazole. A propensity score model was used to generate inverse probability weights for receiving an echinocandin. Initial therapy was defined as the antifungal agent given on the third day after the blood culture was drawn. Patients transferred from another institution and those who died prior to 4 days after the blood culture was drawn were excluded from the analysis. 

Results: There were 2,582 admissions with a Candida BSI; 307 (12%) were due to C. parapsilosis. 126 (41%) patients received fluconazole as initial therapy and 181 (59%) received an echinocandin. The cohort’s median age was 60, majority were male (57%), and the 30-day mortality was 9.8%. In a weighted logistic regression model there was no statistically significant difference in mortality between patients receiving initial therapy with echinocandins compared to fluconazole (OR: 1.14, 95% CI: 0.46 to 2.81). 

Conclusion: Initial therapy with an echinocandin for a C. parapsilosis BSI was not associated with an increase in 30-day mortality when compared with fluconazole in a propensity score weighted model. These data further the support the updated (2015) IDSA candidiasis guidelines that do not favor fluconazole over echinocandins for treatment of C. parapsilosis BSI. Additional research is warranted to investigate differences in time to clearance of candidemia and for other morbidity outcomes.

Neika Vendetti, MPH, Department of Pediatrics, Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, John Baddley, MD, Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, Luis Ostrosky-Zeichner, MD, FIDSA, FSHEA, University of Texas Medical School at Houston, Houston, TX, Peter Pappas, MD, Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, Theoklis Zaoutis, MD, MSCE, FPIDS, Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, the Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA and Brian T. Fisher, DO, MSCE, Division of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosures:

N. Vendetti, Merck: Research Contractor , Research support

J. Baddley, Pfizer: Consultant , Consulting fee
BMS: Grant Investigator , Research grant

L. Ostrosky-Zeichner, None

P. Pappas, None

T. Zaoutis, Merck: Grant Investigator , Research grant

B. T. Fisher, Pfizer: Grant Investigator , Research grant
Merck: Grant Investigator , Research grant

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