Guillermo Cuervo1,2, Carolina Garcia-Vidal1,3, Mireia Puig-Asensio4, Antonio Vena5, Yolanda Meije6, Mario Fernández-Ruiz7, Eva González-Barberá8, María José Blanco-Vidal9, Adriana Manzur10, Celia Cardozo1,3, Carlota Gudiol1,2, José Miguel Montejo9, Javier Pemán8, Josefina Ayats1,2, Jose María Aguado7, Patricia Muñoz5, Francesc Marco1,3, Benito Almirante4, Jordi Carratalà1,2. 1. Department of Infectious Diseases. 2. Hospital Universitari de Bellvitge, Institut D'Investigació Biomèdica de Bellvitge, Department of Microbiology, Universitat de Barcelona. 3. Hospital Clínic, Department of Microbiology, Centre Diagnòstic Biomèdic and ISGlobal, Barcelona Centre for International Health Research, Universitat de Barcelona. 4. Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona. 5. Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón e Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid. 6. Department of Infectious Diseases, Hospital de Barcelona. 7. Department of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Hospital "12 de Octubre", Universidad Complutense de Madrid. 8. Department of Microbiology Hospital Universitari I Politecnic "La Fe,"Valencia, and. 9. Department of Infectious Diseases, Hospital Universitario "Cruces,"Bilbao, Spain; and. 10. Department of Infectious Diseases, Hospital "Dr Guillermo Rawson,"San Juan, Argentina.
Abstract
BACKGROUND: Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes. METHODS: A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model. RESULTS: Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure. CONCLUSIONS: Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.
BACKGROUND: Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes. METHODS: A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model. RESULTS: Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure. CONCLUSIONS: Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.
Authors: Marco Falcone; Giusy Tiseo; Belen Gutiérrez-Gutiérrez; Giammarco Raponi; Paolo Carfagna; Chiara Rosin; Roberto Luzzati; Diego Delle Rose; Massimo Andreoni; Alessio Farcomeni; Mario Venditti; Jesus Rodríguez-Baño; Francesco Menichetti Journal: Open Forum Infect Dis Date: 2019-07-16 Impact factor: 3.835