Droney Madeline, Reed Erica, Sarwar Sajed, Coe Kelci, Tran Nikki
Department of Pharmacy, The University of Kansas Health System, Kansas City, KS, USA.
Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Antimicrob Chemother. 2025 Apr 2;80(4):996-1000. doi: 10.1093/jac/dkaf026.
Candida glabrata is the second most common species responsible for invasive candidiasis, including candidaemia. Echinocandins are typically the first-line therapy for C. glabrata candidaemia, with the option to transition to oral fluconazole. Studies are needed to evaluate clinical outcomes in patients initially treated with echinocandins then transitioned to fluconazole.
This was a retrospective, single-centre cohort study of patients with C. glabrata candidaemia from November 2011 to August 2023. Inpatients aged 18-89 years who received an echinocandin within 24 h of the initial positive blood culture were included. Patients were excluded if they received antifungal treatment less than 48 h, combination therapy, or fluconazole as initial therapy. The primary composite outcome was 30-day clinical failure.
A total of 186 patients were included (n = 153 echinocandin only; n = 33 fluconazole step-down). The most common source of candidaemia was line-associated in both groups with the majority having source control (43% echinocandin versus 58% fluconazole; P = 0.32). Compared to fluconazole, patients in the echinocandin group had a higher rate of concomitant bacteraemia (45% versus 24%; P = 0.03) and endovascular complications (11% versus 0%; P = 0.05). There was no significant difference in treatment duration between echinocandin and fluconazole (16 versus 19 days; P = 0.46), incidence of persistent candidaemia (22% versus 24%; P = 0.7), or 30-day clinical failure (15% versus 9%; P = 0.58).
Fluconazole appears to be a safe and reasonable step-down therapy in the management of C. glabrata candidaemia.
光滑念珠菌是引起侵袭性念珠菌病（包括念珠菌血症）的第二常见菌种。棘白菌素类药物通常是治疗光滑念珠菌血症的一线疗法，也可选择过渡到口服氟康唑治疗。需要开展研究以评估初始接受棘白菌素类药物治疗后过渡到氟康唑治疗的患者的临床结局。
这是一项对2011年11月至2023年8月期间患有光滑念珠菌血症患者的回顾性单中心队列研究。纳入初始血培养阳性后24小时内接受棘白菌素类药物治疗的18至89岁住院患者。若患者接受抗真菌治疗少于48小时、接受联合治疗或初始治疗使用氟康唑，则将其排除。主要复合结局为30天临床治疗失败。
共纳入186例患者（仅接受棘白菌素类药物治疗的患者n = 153例；接受氟康唑降阶梯治疗的患者n = 33例）。两组念珠菌血症最常见的来源均与血管内导管相关，且大多数患者的感染源得到了控制（仅接受棘白菌素类药物治疗组为43%，氟康唑降阶梯治疗组为58%；P = 0.32）。与氟康唑组相比，棘白菌素类药物治疗组患者合并菌血症（45%对24%；P = 0.03）和血管内并发症（11%对0%；P = 0.05）的发生率更高。棘白菌素类药物治疗组和氟康唑治疗组在治疗持续时间（16天对19天；P = 0.46）、持续性念珠菌血症发生率（22%对24%；P = 0.7）或30天临床治疗失败率（15%对9%；P = 0.58）方面无显著差异。
在光滑念珠菌血症的治疗中，氟康唑似乎是一种安全且合理的降阶梯治疗药物。
