Breakthrough candidaemia in the era of broad-spectrum antifungal therapies

Autores de IIS La Fe

• Francesc Puchades Gimeno

  Autor

• 

  Javier Pemán García

  Autor

Participantes ajenos a IIS La Fe

• Cuervo G
• Garcia-Vidal C
• Nucci M
• Fernández-Ruiz M
• Obed M
• Manzur A
• Gudiol C
• Aguado JM
• Ayats J
• Carratalà J

Grupos

• Infección Grave

  

  Investigador Principal

  María Ángeles Tormo Mas

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: I I% 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. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Keywords

• Antifungal therapy; breakthrough infection; candidaemia; posaconazole; prophylaxis