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Breakthrough candidemia in the era of broad-spectrum antifungal therapies.
Clin Microbiol Infect. 2015 Oct 9;
Authors: Cuervo G, Garcia-Vidal C, Nucci M, Puchades F, Fernández-Ruiz M, Obed M, Manzur A, Gudiol C, Pemán J, María Aguado J, Ayats J, Carratalà J
Abstract
We aimed to assess the characteristics, treatment, risk factors and outcome of patients with breakthrough candidemia (BrC) in the era of broad-spectrum antifungal therapies. We carried out a multicenter study of hospitalized adults with candidemia at six hospitals in three countries. BrC episodes were compared to the remaining (non-BrC). Of 409 episodes of candidemia, 37 (9%) were BrC. Among them, antifungal treatment was administered as prophylaxis in 26 severely immunosuppressed patients (70%) and as a fever-driven approach in 11 (30%). Candida albicans was significantly less common in patients with BrC (24% vs. 46%, p=.010) whereas C. krusei was more frequent (16% vs. 2.4%, p<.001). BrC was associated with infections due to fluconazole non-susceptible isolates (50% vs. 18%, p<.001). C. albicans BrC was associated with prior fluconazole treatment while C. parapsilosis candidemia was mostly catheter-related and/or associated with prior echinocandin therapy. The empirical antifungal therapy was more often appropriate in the non-BrC group (57% vs. 74%, p=.055). No significant differences were found in outcomes (early and overall mortality: 11% vs. 13% p=.802 and 40% vs. 40% p=.954, respectively). Fluconazole non-susceptibility was independently associated with the risk of BrC (AOR, 5.57; 95% CI, 1.45-21.37). In conclusion, BrC accounted for 9% of the episodes in our multicenter cohort. The Candida spp. isolated were different depending on the prior antifungal therapy: prior azole treatment was associated with fluconazole non-susceptible strains and prior echinocandin with BrC candidemia caused by C. parapsilosis. These results should be taken into account to improve the empirical treatment of BrC.
PMID: 26460064 [PubMed - as supplied by publisher]