De-escalation from Echinocandins to Azole Treatment in Critically Ill Patients with Candidemia. (August 2022)

• Record Type: Journal Article
• Authors: Lin, Jing; Zhou, Menglan; Chen, Jialong; Zhang, Li; Lu, Minya; Liu, Zhengyin
• Is Part Of: International journal of infectious diseases. Volume 121(2022)
• Page Start: 69
• Page End: 74
• Publication Date: 2022-08
• Subjects: Candidemia -- Critically ill -- De-escalation -- Mortality; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2022.04.044
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: De-escalation is feasible with the duration of echinocandin treatment of ≤5 days. The sequential organ failure assessment score may help physicians withdraw echinocandins early and safely. Early de-escalation can reduce the length of hospitalization. Abstract: Objectives: This study aims to further explore the duration of echinocandins and analyze the de-escalation (DE) strategy in patients with candidemia. Methods: Multivariable logistic regression was used to evaluate the association between the duration of echinocandins (≤ 5-day group vs > 5-day group) and in-hospital mortality. Results: Of the 357 cases of candidemia, 200 patients (56.02%) were identified in the ≤5-day group. The ≤5-day group did not have a higher in-hospital mortality than the >5-day group in the multivariable model (odds ratio [OR] 1.536, 95% confidence interval (CI) 0.837–2.819, P -value = 0.166), and the finding was validated by the propensity score matching and inverse probability of treatment weighting models. Subgroup analyses showed that patients in the ≤5-day group without DE may have a poor prognosis (OR 4.223, 95% CI 1.773–10.055, P -value = 0.001). The patients in the ≤5-day group, with a sequential organ failure assessment (SOFA) score of ≥3 evaluated at the time of stopping echinocandins, may have a poor prognosis (OR 2.164, 95% CI 1.009–4.641, P -value = 0.047). Conclusion: In critically ill adult patients with candidemia, the ≤5-day group with DE was feasible. However, the SOFA score was recommended when stopping echinocandins to ensure the safety of DE therapy.