Infection and Drug Resistance (Jul 2020)

Echinocandins versus Amphotericin B Against Candida tropicalis Fungemia in Adult Hematological Patients with Neutropenia: A Multicenter Retrospective Cohort Study

  • You L,
  • Yao C,
  • Yang F,
  • Yang Q,
  • Lan J,
  • Song X,
  • Shen J,
  • Sheng X,
  • Chen X,
  • Tang H,
  • Jiang H,
  • Wu H,
  • Qian S,
  • Meng H

Journal volume & issue
Vol. Volume 13
pp. 2229 – 2235

Abstract

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Liangshun You,1,* Cunying Yao,1,2,* Fan Yang,3 Qing Yang,4 Jianping Lan,5 Xiaolu Song,5 Jianping Shen,6 Xianfu Sheng,6 Xiaohui Chen,7 Huifen Tang,7 Huifang Jiang,8 Haiying Wu,8 Shenxian Qian,3 Haitao Meng1 1Department of Hematology, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People’s Republic of China; 2Department of Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 3Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People’s Republic of China; 5Department of Hematology, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China; 6Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 7Department of Hematology, The Affiliated Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China; 8Department of Hematology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Haitao Meng; Shenxian Qian Email [email protected]; [email protected]: Candida tropicalis is the most common non-albicans Candida species identified in immunocompromised patients, which often appears with high mortality. However, data on the outcomes of treatment for Candida tropicalis fungemia in patients with neutropenia remain limited.Methods: In the present study, 90 neutropenic adult patients with proven Candida tropicalis fungemia, who received initial antifungal therapy, were retrospectively analyzed.Results: These results revealed that the overall 8-day and 30-day mortality among patients in the entire data set were 22.2% and 33.3%, respectively. However, there was no significant difference between the survival and death group, in terms of baseline characteristics. The univariate analysis of risk factors identified the treatment with azole as a predictor of mortality, while treatments that containing amphotericin B were associated with reduced mortality. In addition, the survival rate on day 30 was observed in 60.7% (17/28) of patients who were initially treated with echinocandins, while this was observed in 86.4% (19/22, P= 0.039) and 100% (13/13, P= 0.024) of patients treated with amphotericin B plus echinocandins and amphotericin B, respectively.Conclusion: These data indicate for the first time that the initial therapy with amphotericin B-based agents was associated with a better survival rate and could be assessed as the optimal strategy for the treatment of Candida tropicalis fungemia in patients with neutropenia.Keywords: Candida tropicalis, candidemia, hematological malignancy, neutropenia, amphotericin B, echinocandins

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