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http://hdl.handle.net/2445/181487
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DC Field | Value | Language |
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dc.contributor.author | Moreno García, Estela | - |
dc.contributor.author | Puerta-Alcalde, Pedro | - |
dc.contributor.author | Gariup, Giuseppe | - |
dc.contributor.author | Fernández Ruiz, Mario | - |
dc.contributor.author | López Cortés, Luis Eduardo | - |
dc.contributor.author | Cuervo Requena, Guillermo | - |
dc.contributor.author | Salavert, Miguel | - |
dc.contributor.author | Merino, Paloma | - |
dc.contributor.author | Machado, Marina | - |
dc.contributor.author | Guinea, Jesús | - |
dc.contributor.author | García Rodríguez, Julio | - |
dc.contributor.author | Garnacho Montero, José | - |
dc.contributor.author | Cardozo Espinola, Celia | - |
dc.contributor.author | Peman,Javier | - |
dc.contributor.author | Montejo, Marta | - |
dc.contributor.author | Fortún, Jesús | - |
dc.contributor.author | Almirante, Benito | - |
dc.contributor.author | Castro, Carmen | - |
dc.contributor.author | Rodríguez Baño, Jesús | - |
dc.contributor.author | Aguado, José María | - |
dc.contributor.author | Martínez, J. Alfredo, 1957- | - |
dc.contributor.author | Carratalà, Jordi | - |
dc.contributor.author | Soriano Viladomiu, Alex | - |
dc.contributor.author | Garcia Vidal, Carolina | - |
dc.date.accessioned | 2021-11-25T12:21:24Z | - |
dc.date.available | 2021-11-25T12:21:24Z | - |
dc.date.issued | 2021-05-16 | - |
dc.identifier.issn | 2328-8957 | - |
dc.identifier.uri | http://hdl.handle.net/2445/181487 | - |
dc.description.abstract | Background. There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection. Methods. This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (20072016). The impact of ED and factors associated with mortality were assessed. Results. Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P = .006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P = .043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P = .016), and candidemia from an unknown source (24.1% vs 47%; P = .003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P = .006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48-10.61), Pitt score > 2 (OR, 4.39; 95% CI, 1.94-9.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14-5.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48-10.61), and prior surgery (OR, 0.29; 95% CI, 0.08-0.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16-1.53). Conclusions. Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies. | - |
dc.format.extent | 7 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | Oxford University Press (OUP) | - |
dc.relation.isformatof | Reproducció del document publicat a: https://doi.org/10.1093/ofid/ofab250 | - |
dc.relation.ispartof | Open Forum Infectious Diseases, 2021, vol. 8, num. 6 | - |
dc.relation.uri | https://doi.org/10.1093/ofid/ofab250 | - |
dc.relation.uri | https://doi.org/10.1093/ofid/ofac180 | - |
dc.rights | cc by-nc-nd (c) Moreno García, Estela et al, 2021 | - |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/es/ | * |
dc.source | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) | - |
dc.subject.classification | Candidiasi | - |
dc.subject.classification | Terapèutica | - |
dc.subject.other | Candidiasis | - |
dc.subject.other | Therapeutics | - |
dc.title | Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies | - |
dc.type | info:eu-repo/semantics/article | - |
dc.type | info:eu-repo/semantics/publishedVersion | - |
dc.date.updated | 2021-11-25T11:51:53Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
dc.identifier.pmid | 34104670 | - |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
Files in This Item:
File | Description | Size | Format | |
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ofab250.pdf | 349.26 kB | Adobe PDF | View/Open | |
Correction_Early_Stepdown.pdf | Correction | 112.58 kB | Adobe PDF | View/Open |
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