Impact of biofilm production by Candida species and antifungal therapy on mortality of patients with candidemia.

Impact of biofilm production by Candida species and antifungal therapy on mortality of patients with candidemia.

Mycoses. 2020 Sep 10;:

Authors: Lee CH, Chen YC, Chen IL, Chen FJ, Chien CC

Abstract
BACKGROUND AND OBJECTIVES: Few studies have investigated the clinical outcomes of patients with candidemia caused by Candida species with different levels of biofilm formation. We aimed to investigate the impact of anti-fungal therapy on the outcome of candidemia caused by Candida species that were categorized as low biofilm formers (LBFs), moderate biofilm formers (MBFs), and high biofilm formers (HBFs).
METHODS: Adults with candidemia caused by LBF and HBF/MBF Candida species that were susceptible to fluconazole and caspofungin were included to investigate the impact of treatment with fluconazole versus an echinocandin on 30-day crude mortality.
RESULTS: In total, 215 patients with candidemia received fluconazole and 116 patients received an echinocandin. In multivariate analysis, Pittsburgh bacteremia score ≥ 4 (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI], 1.32-4.41), malignancy (AOR = 3.45; 95% CI, 1.83-6.51), not removing the central venous catheter within 48 hours of a positive blood culture (AOR = 4.69; 95% CI, 2.61-8.45), and treatment with fluconazole for candidemia due to HBF/MBF Candida spp. (AOR = 2.23; 95% CI, 1.22-4.06) were independent factors associated with 30-day mortality. Of the 165 patients infected by HBF/MBF Candida isolates, those who received azole therapy had a significantly higher sepsis-related mortality rate than those who received echinocandin therapy (44.9% [49/109] vs. 26.8% [15/56], p = 0.03).
CONCLUSIONS: There was a trend of an independent association between fluconazole treatment and poor outcomes in the patients infected by HBF/MBF Candida strains.

PMID: 32910518 [PubMed - as supplied by publisher]