Impact of Treatment Strategy on Outcomes in Patients with Candidemia and Other Forms of Invasive Candidiasis: A Patient-Level Quantitative Review of Randomized Trials

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ID: 305645
2012
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Ranked #372 of 635 articles by views in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

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Abstract
(See the Editorial Commentary by Clancy and Nguyen, on pages 1123–5.) 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 = .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.
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Authors David R. Andes, Nasia Safdar, John W. Baddley, Geoffrey Playford, Annette C. Reboli, John Rex, J. D. Sobel, P. G. Pappas, Bart Jan Kullberg
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Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2012
DOI
10.1093/cid/cis021
URL
https://doi.org/10.1093/cid/cis021
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