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Observational Study
. 2017 May 15;64(10):1374-1379.
doi: 10.1093/cid/cix033.

Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis

Guillermo Cuervo  1   2 , Carolina Garcia-Vidal  1   3 , Mireia Puig-Asensio  4 , Antonio Vena  5 , Yolanda Meije  6 , Mario Fernández-Ruiz  7 , Eva González-Barberá  8 , María José Blanco-Vidal  9 , Adriana Manzur  10 , Celia Cardozo  1   3 , Carlota Gudiol  1   2 , José Miguel Montejo  9 , Javier Pemán  8 , Josefina Ayats  1   2 , Jose María Aguado  7 , Patricia Muñoz  5 , Francesc Marco  1   3 , Benito Almirante  4 , Jordi Carratalà  1   2 ; for Grupo de Estudio de Micología Médica (GEMICOMED), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC); and Red Española de Investigación en Patología Infecciosa (REIPI)
Affiliations
Observational Study

Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis

Guillermo Cuervo et al. Clin Infect Dis. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2017 Oct 15;65(8):1431-1433. doi: 10.1093/cid/cix563. Clin Infect Dis. 2017. PMID: 29017252 Free PMC article. No abstract available.
  • Erratum.
    [No authors listed] [No authors listed] Clin Infect Dis. 2017 Aug 15;65(4):707. doi: 10.1093/cid/cix451. Clin Infect Dis. 2017. PMID: 29017274 No abstract available.

Abstract

Background: Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes.

Methods: A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model.

Results: Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure.

Conclusions: Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.

Keywords: candidemia; echinocandin therapy; propensity score.; urinary source.

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