The last decade has seen modifications in the management of fungemia with the commercialization of echinocandins, the triazoles prophylaxis in hematology, and the publication of several guidelines.
The data collected through the active surveillance program on fungemia with 26 short-stay university participating hospitals in the Paris area from January 2003 to December 2014 were analyzed. The adult patients were grouped in hematology, oncology (solid tumors), and no malignancy patients, each group further divided in ICU or outside ICU. Only the first-line antifungal drug prescribed was analyzed.
The cohort included 3620 patients (60.5% male, mean age 59.8±16.9 yr.) and 3922 isolates with stable species proportion overtime (Candida albicans: 50.5%; C. glabrata: 18%; C. parapsilosis: 8.8%; C. tropicalis: 8.8%, C. krusei: 3.1%; and other species: 9.3%). No increase in acquired resistance was observed. Global mortality at day 30 was 39.9%, higher in ICU compared with outside ICU, but stable in hematology, oncology patients and no malignancy patients, except for oncology patients in ICU with a significant increase (Chi2 for trends, P=0.032). Survivals according to the 6 common species were similar with fluconazole and echinocandins. Only the absence of treatment was significantly associated with an increased mortality (P<0.001). The global prescription of fluconazole as first-line therapy dramatically decreased (P<0.0001) with a corresponding increase in echinocandins.
The changes in the management of candidemia have not significantly modified the epidemiology and outcome in adult patients. Other factors remain to be investigated to improve the high mortality rate.El texto completo de este artículo está disponible en PDF.