Aljohani Ahmad, Alqahtani Saeed
Pharmaceutical Care Services, King Fahd General Hospital, Ministry of Health, Jeddah, Saudi Arabia.
Department of Pharmacy, College of Pharmacy, Nursing and Medical Sciences, Riyadh Elm University, Riyadh, Saudi Arabia.
Infect Drug Resist. 2024 Jul 9;17:2863-2871. doi: 10.2147/IDR.S462301. eCollection 2024.
Echinocandins are used to treat invasive candidiasis (IC), with FDA-approved doses indicated for both obese and non-obese patients. Pharmacokinetic (PK) studies have identified subtherapeutic exposure in obese patients receiving standard doses (SDs) of echinocandins. However, research on clinical outcome differences of echinocandins' SDs between obese and non-obese patients is lacking. Therefore, this study aimed to evaluate the effectiveness of echinocandins' SDs in obese compared to normal-weight patients with IC.
This retrospective cohort study was conducted at King Saud University Medical City (KSUMC) from Jan 2017 to Feb 2023. The study included adult patients diagnosed with infections who received ≥ 4 doses of echinocandins. Patients with body mass index (BMI) less than 18 kg/m were excluded from the study. The primary and secondary outcomes included the total length of stay (LOS), IC duration, frequency of clinical resolution and all-cause mortality.
This study included 132 patients (47 obese; 85 non-obese) with a median age of 61 years. The median BMI and weight were different between the obese (34.5 kg/m, 88 kg) and non-obese (24 kg/m, 65 kg) groups (P= 0.01). Micafungin and caspofungin were used in 63.6% and 36.4% of patients, respectively. The total LOS and length of IC infections were similar between both groups, with median values of 29.5 days (P= 0.896) and 18 days (P = 0.160), respectively. The clinical improvement percentages were 68.1% for obese and 65.9% for non-obese patients (P= 0.797), with all-cause mortality rates at 44.7% and 42.4%, respectively (P= 0.796).
The study found no clinical outcome differences between obese and non-obese patients, with Similar effectiveness of the echinocandins' SDs in both groups. Further research in multi-centre settings is recommended to detect any potential differences between the two groups.
棘白菌素用于治疗侵袭性念珠菌病（IC），美国食品药品监督管理局（FDA）批准的剂量适用于肥胖和非肥胖患者。药代动力学（PK）研究已确定接受标准剂量（SD）棘白菌素治疗的肥胖患者存在治疗不足的暴露情况。然而，缺乏关于肥胖和非肥胖患者之间棘白菌素SD临床结局差异的研究。因此，本研究旨在评估与体重正常的IC患者相比，棘白菌素SD在肥胖患者中的有效性。
本回顾性队列研究于2017年1月至2023年2月在沙特国王大学医学城（KSUMC）进行。该研究纳入了诊断为感染且接受≥4剂棘白菌素治疗的成年患者。体重指数（BMI）低于18kg/m的患者被排除在研究之外。主要和次要结局包括住院总时长（LOS）、IC持续时间、临床缓解频率和全因死亡率。
本研究纳入了132例患者（47例肥胖；85例非肥胖），中位年龄为61岁。肥胖组（34.5kg/m²，88kg）和非肥胖组（24kg/m²，65kg）的中位BMI和体重存在差异（P = 0.01）。分别有63.6%和36.4%的患者使用了米卡芬净和卡泊芬净。两组的总LOS和IC感染时长相似，中位值分别为29.5天（P = 0.896）和18天（P = 0.160）。肥胖患者的临床改善百分比为68.1%，非肥胖患者为65.9%（P = 0.797），全因死亡率分别为44.7%和42.4%（P = 0.796）。
该研究发现肥胖和非肥胖患者之间无临床结局差异，两组中棘白菌素SD的有效性相似。建议在多中心环境中进行进一步研究，以检测两组之间的任何潜在差异。
