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. 2021 Oct;70(10):001434.
doi: 10.1099/jmm.0.001434.

Clinical efficacy and safety of antifungal drugs for the treatment of Candida parapsilosis infections: a systematic review and network meta-analysis

Jielin Qin  1 , Han Yang  2 , Zhiming Shan  3 , Lingzhi Jiang  4 , Qingxian Zhang  1
Affiliations

Clinical efficacy and safety of antifungal drugs for the treatment of Candida parapsilosis infections: a systematic review and network meta-analysis

Jielin Qin et al. J Med Microbiol. 2021 Oct.

Abstract

Antifungal drugs have already been established as an effective treatment option for Candida parapsilosis infections, but there is no universal consensus on the ideal target for clinical efficacy and safety of antifungal drugs for the treatment of C. parapsilosis infections. Few studies have directly compared the efficacies of antifungal drugs for the treatment of C. parapsilosis infections. We hypothesize that different antifungal drugs offer differing clinical efficacy and safety for the treatment of C. parapsilosis infections. We performed a comprehensive network meta-analysis on different strategies for C. parapsilosis infection treatment and compared the clinical efficacy and safety of antifungal drugs as interventions for C. parapsilosis infections. The Cochrane Database of Systematic Reviews, Medline, Embase, PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Technology of Chongqing VIP database, Wan Fang Data, and SinoMed databases were searched to identify appropriate randomized trials. Among the extracted C. parapsilosis cases, the survival and death rates with treatment of C. parapsilosis infection were compared among groups treated with different antifungal drugs. According to the evidence-network analysis, echinocandins were a better choice than other drugs for treating C. parapsilosis infections, and more importantly, caspofungin showed a more preferable effect for decreasing the risk of 30 day mortality. In conclusion, this study systematically evaluated the effectiveness and safety of antifungal drugs for the purpose of helping clinicians choose the most appropriate antifungal drugs. Future studies with larger samples are needed to evaluate the effects of patient factors on the clinical efficacy and safety of antifungal drugs for C. parapsilosis infections.

Keywords: Candida parapsilosis; antifungal drugs; clinical efficacy; meta-analysis; safety.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the study selection process.
Fig. 2.
Fig. 2.
Risk of bias for all individual studies included in the analysis. The risk of bias graph shows the reviewers’ assessment of the risk of bias shown as percentages for all included studies.
Fig. 3.
Fig. 3.
Network graph of included studies reporting outcomes. Each node represents a therapy with the thickness of the line and size of the circle proportional to the number of studies and number of participants, respectively, in the head-to-head comparison. Abbreviations: CAS, Caspofungin; AND, Anidulafungin; AMP, Amphotericin B; MIC, Micafungin; ISA, Isavuconazole; FLU, Fluconazole.
Fig. 4.
Fig. 4.
Forest plot of included studies for comparing the overall efficacy of antifungal drugs in the included studies.
Fig. 5.
Fig. 5.
Evidence-network analysis for paired-comparison of the efficacy of antifungal drugs in the included studies.
Fig. 6.
Fig. 6.
Contribution plot for the included studies.
Fig. 7.
Fig. 7.
Comparisons of 30 day mortality. Summarized RR and corresponding 95 % CI for 30 day mortality comparing multiple treatments.
Fig. 8.
Fig. 8.
Comparison-adjusted funnel plot for the network meta-analysis.
See this image and copyright information in PMC

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