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
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]