1598. Initial treatment of cancer patients with fluconazole-intermediate C. glabrata fungemia with an echinocandin or polyene is associated with better survival than initial treatment with an azole
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Echino vs azole 10-23-16 REVISED.pdf (332.9 kB)
  • Background: Candida glabrata is one of the 2-3 most frequent Candida species causing invasive candidiasis, and the main species developing multi-drug resistance. In population studies, up to 2/3 of C. glabrata isolates are non-susceptible to azoles, which should be used with caution against this pathogen. However, some studies showed comparable clinical outcomes between azoles and echinocandins for treatment of C. glabrata infections. We compared all-cause mortality between cancer patients with C. glabrata fungemia treated within the first 48 hours after blood culture collection with an azole and those treated with an echinocandin or polyene.

    Methods: We identified cancer patients with ≥1 blood culture(s) positive for fluconazole-intermediate (MIC <32 mg/L) C. glabrata seen at MD Anderson Cancer Center between 3/2005 and 9/2013, who received antifungal treatment within the first 48 hours after blood culture collection. We retrospectively reviewed their clinical and laboratory data on the day of blood culture collection.

    Results: We studied 75 patients. 36 (48%) were female and the mean age (standard deviation) was 53 (16). 12 patients (16%) had acute leukemia, and 16 (21%) were neutropenic (<500 neutrophils/μL). 28-day survival was 62% (28/45) with initial echinocandin or polyene and 47% (14/30) with initial azole treatment. In neutropenic patients, 28-day survival was 56% (5/9) with initial echinocandin or polyene and 29% (2/7) with initial azole treatment. In multivariate Cox regression analysis, ICU stay (HR 3, p=0.01), APACHE II score (HR 1.1 per unit, p=0.04), monocytopenia (<100 monocytes/μL, HR 4.4, p<0.001), absence of fever (HR 2.2, p=0.04) and azole monotherapy within the first 48 hours after blood culture collection (HR 2.2, p=0.03) were associated with increased 28-day mortality.

    Conclusion: In this small series of cancer patients with C. glabrata fungemia, excluding those who did not receive an antifungal or had fluconazole-resistant isolates, we noted a trend towards increased all-cause mortality with azole monotherapy, after adjustment for other clinical confounders. Azole monotherapy as initial treatment should be avoided in cancer patients with suspected C. glabrata fungemia, even in those without neutropenia.

    Dimitrios Farmakiotis, MD, Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, Audrey Le, MD, Department of Internal Medicine, Warren Alpert Medical School of Brown University, Providence, RI, Jeffrey Tarrand, MD, Laboratory Medicine, University of Texas MD Anderson Cancer Center, Houston, TX and Dimitrios P. Kontoyiannis, MD, ScD, FIDSA, Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

    Disclosures:

    D. Farmakiotis, None

    A. Le, None

    J. Tarrand, None

    D. P. Kontoyiannis, •: Advisory Board , Research support
    Pfizer: Research grant , Research support
    Gilead: Invited lecturer , Speaker honorarium
    Astellas: Consultant , Research support and Speaker honorarium
    F2G: Consultant , Consulting fee
    T2 Biosystems: Invited lecturer , Speaker honorarium
    Mylan Inc: Invited lecturer , Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.