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- Title
Impact of Treatment Strategy on Outcomes in Patients with Candidemia and Other Forms of Invasive Candidiasis: A Patient-Level Quantitative Review of Randomized Trials.
- Authors
Andes, David R.; Safdar, Nasia; Baddley, John W.; Playford, Geoffrey; Reboli, Annette C.; Rex, John H.; Sobel, Jack D.; Pappas, Peter G.; Kullberg, Bart Jan
- Abstract
Background. Invasive candidiasis (IC) is an important healthcare-related infection, with increasing incidence and a crude mortality exceeding 50%. Numerous treatment options are available yet comparative studies have not identified optimal therapy Methods. We conducted an individual patient-level quantitative review of randomized trials for treatment of IC and to assess the impact of host-, organism-, and treatment-related factors on mortality and clinical cure. Studies were identified by searching computerized databases and queries of experts in the field for randomized trials comparing the effect of ≤2 antifungals for treatment of IC. Univariate and multivariable analyses were performed to determine factors associated with patient outcomes Results. Data from 1915 patients were obtained from 7 trials. Overall mortality among patients in the entire data set was 31.4%, and the rate of treatment success was 67.4%. Logistic regression analysis for the aggregate data set identified increasing age (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.02; P = .02), the Acute Physiology and Chronic Health Evaluation II score (OR, 1.11; 95% CI, 1.08-1.14; P = .0001), use of immunosuppressive therapy (OR, 1.69; 95% CI, 1.18-2.44; P = .001), and infection with Candida tropicalis (OR, 1.64; 95% CI, 1.11-2.39; P 5 .01) as predictors of mortality. Conversely, removal of a central venous catheter (CVC) (OR, 0.50; 95% CI, .35-.72; P = .0001) and treatment with an echinocandin antifungal (OR, 0.65; 95% CI, .45-.94; P = .02) were associated with decreased mortality. Similar findings were observed for the clinical success end point Conclusions. Two treatment-related factors were associated with improved survival and greater clinical success: use of an echinocandin and removal of the CVC.
- Subjects
CANDIDIASIS; BLOOD microbiology; DISEASE incidence; MORTALITY; HEALTH outcome assessment; RANDOMIZED controlled trials; COMPARATIVE studies
- Publication
Clinical Infectious Diseases, 2012, Vol 54, Issue 8, p1110
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/cis021