Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment

Karen Rokkedal Lausch; Mette Søgaard; Flemming Schønning Rosenvinge; Helle Krogh Johansen; Trine Boysen; Bent Løwe Røder; Klaus Leth Mortensen; Lene Nielsen; Lars Lemming; Bente Olesen; Christine Leitz; Lise Kristensen; Esad Dzajic; Lars Jørgen Østergaard; Henrik Carl Schønheyder; Maiken Cavling Arendrup

doi:10.2147/IDR.S176384

Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment

Karen Rokkedal Lausch, Mette Søgaard, Flemming Schønning Rosenvinge, Helle Krogh Johansen, Trine Boysen, Bent Løwe Røder, Klaus Leth Mortensen, Lene Nielsen, Lars Lemming, Bente Olesen, Christine Leitz, Lise Kristensen, Esad Dzajic, Lars Jørgen Østergaard, Henrik Carl Schønheyder, Maiken Cavling Arendrup

Department of Clinical Medicine

4 Citations (Scopus)

27 Downloads (Pure)

Abstract

Background: In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes.

Materials and methods: Incident candidemia cases from a 2-year period, 2010-2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression.

Results: A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55-1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28-0.89), but not for patients with Candida albicans or Candida tropicalis.

Conclusion: The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted.

Original language	English
Journal	Infection and Drug Resistance
Volume	11
Pages (from-to)	2449-2459
Number of pages	11
ISSN	1178-6973
DOIs	https://doi.org/10.2147/IDR.S176384
Publication status	Published - 2018

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Lausch, K. R., Søgaard, M., Rosenvinge, F. S., Johansen, H. K., Boysen, T., Røder, B. L., Mortensen, K. L., Nielsen, L., Lemming, L., Olesen, B., Leitz, C., Kristensen, L., Dzajic, E., Østergaard, L. J., Schønheyder, H. C., & Arendrup, M. C. (2018). Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment. Infection and Drug Resistance, 11, 2449-2459. https://doi.org/10.2147/IDR.S176384

Lausch, KR, Søgaard, M, Rosenvinge, FS, Johansen, HK , Boysen, T, Røder, BL, Mortensen, KL, Nielsen, L, Lemming, L, Olesen, B, Leitz, C, Kristensen, L, Dzajic, E, Østergaard, LJ, Schønheyder, HC & Arendrup, MC 2018, 'Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment', Infection and Drug Resistance, vol. 11, pp. 2449-2459. https://doi.org/10.2147/IDR.S176384

@article{d0ecbf7f46784eecb980588f9f67077b,

title = "Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment",

abstract = "Background: In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes.Materials and methods: Incident candidemia cases from a 2-year period, 2010-2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression.Results: A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55-1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28-0.89), but not for patients with Candida albicans or Candida tropicalis.Conclusion: The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted.",

author = "Lausch, {Karen Rokkedal} and Mette S{\o}gaard and Rosenvinge, {Flemming Sch{\o}nning} and Johansen, {Helle Krogh} and Trine Boysen and R{\o}der, {Bent L{\o}we} and Mortensen, {Klaus Leth} and Lene Nielsen and Lars Lemming and Bente Olesen and Christine Leitz and Lise Kristensen and Esad Dzajic and {\O}stergaard, {Lars J{\o}rgen} and Sch{\o}nheyder, {Henrik Carl} and Arendrup, {Maiken Cavling}",

year = "2018",

doi = "10.2147/IDR.S176384",

language = "English",

volume = "11",

pages = "2449--2459",

journal = "Infection and Drug Resistance",

issn = "1178-6973",

publisher = "Dove Medical Press Ltd",

}

TY - JOUR

T1 - Treatment of candidemia in a nationwide setting

T2 - increased survival with primary echinocandin treatment

AU - Lausch, Karen Rokkedal

AU - Søgaard, Mette

AU - Rosenvinge, Flemming Schønning

AU - Johansen, Helle Krogh

AU - Boysen, Trine

AU - Røder, Bent Løwe

AU - Mortensen, Klaus Leth

AU - Nielsen, Lene

AU - Lemming, Lars

AU - Olesen, Bente

AU - Leitz, Christine

AU - Kristensen, Lise

AU - Dzajic, Esad

AU - Østergaard, Lars Jørgen

AU - Schønheyder, Henrik Carl

AU - Arendrup, Maiken Cavling

PY - 2018

Y1 - 2018

N2 - Background: In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes.Materials and methods: Incident candidemia cases from a 2-year period, 2010-2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression.Results: A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55-1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28-0.89), but not for patients with Candida albicans or Candida tropicalis.Conclusion: The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted.

AB - Background: In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes.Materials and methods: Incident candidemia cases from a 2-year period, 2010-2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression.Results: A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55-1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28-0.89), but not for patients with Candida albicans or Candida tropicalis.Conclusion: The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted.

U2 - 10.2147/IDR.S176384

DO - 10.2147/IDR.S176384

M3 - Journal article

C2 - 30538511

SN - 1178-6973

VL - 11

SP - 2449

EP - 2459

JO - Infection and Drug Resistance

JF - Infection and Drug Resistance

ER -

Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment

Abstract

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