Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: A patient-level quantitative review of randomized trials

Andes, David R., Safdar, Nasia, Baddley, John W., Playford, Geoffrey, Reboli, Annette C., Rex, John H., Sobel, Jack D., Pappas, Peter G., Kullberg, Bart Jan and Mycoses Study Group (2012) Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: A patient-level quantitative review of randomized trials. Clinical Infectious Diseases, 54 8: 1110-1122. doi:10.1093/cid/cis021


Author Andes, David R.
Safdar, Nasia
Baddley, John W.
Playford, Geoffrey
Reboli, Annette C.
Rex, John H.
Sobel, Jack D.
Pappas, Peter G.
Kullberg, Bart Jan
Mycoses Study Group
Total Author Count Override 9
Title Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: A patient-level quantitative review of randomized trials
Journal name Clinical Infectious Diseases   Check publisher's open access policy
ISSN 1058-4838
1537-6591
Publication date 2012-04
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1093/cid/cis021
Volume 54
Issue 8
Start page 1110
End page 1122
Total pages 13
Place of publication Cary, NC, United States
Publisher Oxford University Press
Collection year 2013
Language eng
Formatted abstract
     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.
Keyword Blood-stream infection
Critically-ill patients
Intensive-care-unit
Hospital-acquired candidemia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
Australian Institute for Bioengineering and Nanotechnology Publications
 
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