Breakthrough candidaemia in the era of broad-spectrum antifungal therapies. (February 2016)

• Record Type: Journal Article
• Authors: Cuervo, G.; Garcia-Vidal, C.; Nucci, M.; Puchades, F.; Fernández-Ruiz, M.; Obed, M.; Manzur, A.; Gudiol, C.; Pemán, J.; Aguado, J.M.; Ayats, J.; Carratalà, J.
• Is Part Of: Clinical microbiology and infection. Volume 22:Number 2(2016)
• Page Start: 181
• Page End: 188
• Publication Date: 2016-02
• Subjects: Antifungal therapy -- breakthrough infection -- candidaemia -- posaconazole -- prophylaxis; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2015.09.029
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: We aimed to assess the characteristics, treatment, risk factors and outcome of patients with breakthrough candidaemia (BrC) in the era of broad-spectrum antifungal therapies. We carried out a multicentre study of hospitalized adults with candidaemia at six hospitals in three countries. BrC episodes were compared with the remaining episodes (non-BrC). Of 409 episodes of candidaemia, 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% versus 46%, p 0.010) whereas Candida krusei was more frequent (16% versus 2.4%, p < 0.001). BrC was associated with infections caused by fluconazole non-susceptible isolates (50% versus 18%, p < 0.001). Candida albicans BrC was associated with previous fluconazole treatment whereas Candida parapsilosis candidaemia was mostly catheter-related and/or associated with previous echinocandin therapy. The empirical antifungal therapy was more often appropriate in the non-BrC group (57% versus 74%, p 0.055). No significant differences were found in outcomes (early and overall mortality: 11% versus 13% p 0.802 and 40% versus 40% p 0.954, respectively). Fluconazole non-susceptibility was independently associated with the risk of BrC (adjusted OR 5.57; 95% CI 1.45–21.37). In conclusion, BrC accounted for 9% of the episodes in our multicentre cohort. The Candida spp. isolated were different depending on the previous antifungal therapy: previous azole treatment was associated with fluconazole non-susceptible strains and previous echinocandin treatment was associated with BrC caused by C. parapsilosis . These results should be taken into account to improve the empirical treatment of BrC.