Falcone Marco, Tiseo Giusy, Gutiérrez-Gutiérrez Belen, Raponi Giammarco, Carfagna Paolo, Rosin Chiara, Luzzati Roberto, Delle Rose Diego, Andreoni Massimo, Farcomeni Alessio, Venditti Mario, Rodríguez-Baño Jesus, Menichetti Francesco
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
Open Forum Infect Dis. 2019 Jul 16;6(7):ofz251. doi: 10.1093/ofid/ofz251. eCollection 2019 Jul.
Echinocandins are recommended as firstline therapy in patients with candidemia. However, there is debate on their efficacy in survival outcomes. The aim of this study is to evaluate whether the choice of initial antifungal therapy improves mortality in patients with candidemia in relation to the presence of septic shock.
Patients with candidemia hospitalized in internal medicine wards of 5 tertiary care centers were included in the study (December 2012-December 2014). Patient characteristics, therapeutic interventions, and outcome were reviewed. Propensity score (PS) was used as a covariate of the multivariate analysis to perform a stratified analysis according to PS quartiles and to match patients receiving "echinocandins" or "azoles."
Overall, 439 patients with candidemia were included in the study. A total of 172 (39.2%) patients had septic shock. Thirty-day mortality was significantly higher in patients with septic shock (45.3%) compared with those without septic shock (31.5%; = .003). Among patients with septic shock, the use of echinocandins in the first 48 hours, compared with azoles, did not affect 30-day mortality in the PS-adjusted Cox regression analysis (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.37-1.59; = .48), the PS-stratified analysis, or the logistic regression model in matched cohorts (adjusted HR, 0.92; 95% CI, 0.51-1.63; = .77).
Echinocandin therapy seems not to improve the outcome of non-intensive care unit patients with septic shock due to candidemia. These findings support the urgent need of further studies in this patient population.
棘白菌素类药物被推荐为念珠菌血症患者的一线治疗药物。然而，关于其对生存结局的疗效存在争议。本研究的目的是评估初始抗真菌治疗的选择是否能改善念珠菌血症患者伴感染性休克时的死亡率。
本研究纳入了5家三级医疗中心内科病房收治的念珠菌血症患者（2012年12月至2014年12月）。回顾患者的特征、治疗干预措施和结局。倾向评分（PS）用作多变量分析的协变量，以便根据PS四分位数进行分层分析，并对接受“棘白菌素类药物”或“唑类药物”治疗的患者进行匹配。
总体而言，439例念珠菌血症患者纳入本研究。共有172例（39.2%）患者发生感染性休克。感染性休克患者的30天死亡率（45.3%）显著高于无感染性休克患者（31.5%；P = 0.003）。在感染性休克患者中，在PS校正的Cox回归分析中，与唑类药物相比，在最初48小时内使用棘白菌素类药物对30天死亡率无影响（风险比[HR]，0.77；95%置信区间[CI]，0.37 - 1.59；P = 0.48），在PS分层分析或匹配队列中的逻辑回归模型中也是如此（校正后HR，0.92；95% CI，0.51 - 1.63；P = 0.77）。
棘白菌素类药物治疗似乎不能改善因念珠菌血症导致感染性休克的非重症监护病房患者的结局。这些发现支持了对这一患者群体进行进一步研究的迫切需求。
