Echinocandins in the treatment of candidaemia and invasive candidiasis: clinical and economic perspectives

Neoh, Chin Fen; Slavin, Monica A; Chen, Sharon C‐A; Stewart, Kay; Kong, David Chee Ming

doi:10.1016/j.ijantimicag.2013.08.010

Cited by 26 publications

(23 citation statements)

References 89 publications

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“…In addition to high morbidity and mortality, candidemia is also associated with a high economic burden of nearly $300 million annually in the United States (4). Compared to a matched cohort of hospitalized patients without candidemia, hospitalized adult patients with candidemia incurred higher hospital charges, by $39,331, and had hospital stays that were 10.1 days longer (5).…”

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confidence: 99%

“…Fluconazole is considered an acceptable alternative first-line therapy in patients who are not critically ill and who are not likely to have a fluconazole-resistant Candida strain, and the IDSA recommends transition from first-line echinocandin or AmB to fluconazole, usually within a week, for patients who have stabilized and have non-fluconazole-resistant strains (6). The latest IDSA guideline may potentially lead to a gradual shift from first-line fluconazole to first-line echinocandin therapy; however, presently fluconazole is still widely prescribed (4).…”

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confidence: 99%

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A Risk Score for Fluconazole Failure among Patients with Candidemia

Ostrosky-Zeichner¹,

Harrington

Azie

et al. 2017

Antimicrob Agents Chemother

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This study aimed to develop a prediction model to identify patients with candidemia who were at high risk of failing fluconazole treatment. Adult patients in the United States with candidemia who received fluconazole during hospitalization were selected from the Cerner Health Facts Hospital Database (04/2004 to 03/2013). Fluconazole failure was defined as switching/adding another antifungal, positive Candida culture Ն10 days after fluconazole initiation, or death during hospitalization. Patients were randomized into modeling and validation samples. Using the modeling sample, a regression analysis of least absolute shrinkage and selection operator was used to select risk predictors of fluconazole failure (demographics, Candida species, initiation of fluconazole before positive culture and after admission, and comorbidities, procedures, and treatments during the 6 months before admission and fluconazole initiation). The prediction model was evaluated using the validation sample. We found that of 987 identified patients (average age of 61 years, 51% male, 72% Caucasian), 49% failed and 51% did not fail fluconazole treatment. Of those who failed, 70% switched or added another antifungal, 21% had a second positive Candida test, and 42% died during hospitalization. Nine risk factors were included in the prediction model: days to start fluconazole after admission, Candida glabrata or Candida krusei infection, hematological malignancy, venous thromboembolism (VTE), enteral nutrition, use of nonoperative intubation/irrigation, and other antifungal use. All but VTE were associated with a higher risk of failure. The model's c-statistic was 0.65, with a Hosmer-Lemeshow test P value of 0.23. In summary, this prediction model identified patients with a high risk of fluconazole failure, illustrating the potential value and feasibility of personalizing candidemia treatment.

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confidence: 99%

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confidence: 99%

A Risk Score for Fluconazole Failure among Patients with Candidemia

Ostrosky-Zeichner¹,

Harrington

Azie

et al. 2017

Antimicrob Agents Chemother

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“…of Candida (Candidiasis and Candidaemia) and Aspergillus (Aspergillosis). Current medical treatments are of limited utility, and their therapeutic use has been complicated by Candidaemia and invasive Candidiasis (IC), which contribute toward high morbidity and mortality [4]. Candidaemia is the fourth major type of microbial bloodstream infection [5], while Candida albicans being the major causative spp.…”

Section: Introductionmentioning

confidence: 99%

Echinocandins Versus Dated Antifungals in Combination Against Opportunistic Mycotic Infections

Narwal¹,

Balhara²,

Chaudhary³

et al. 2017

Asian J Pharm Clin Res

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Scientific and clinical reports globally demonstrated that the opportunistic mycotic infections are at major risk to the human fitness. In the past few decades, the development of resistance in microbes to existing antifungals has emphasized on the search of new antimycotic drugs. As a matter of fact, "echinocandins" are new categories of broad-spectrum antifungal enlighten a hope in this direction. Echinocandins are bulky lipopeptides that inhibit the production of β-[1,3]-glucan "a major constituent of fungal cell wall" which ultimately leads to the death of fungal pathogens. In vitro as well as in vivo published reports have demonstrated that the echinocandins exhibit fungicidal activity against most Candida spp., while fungistatic against Aspergillus spp. and exclusively found to be more effective when tested in combination with polyenes/azoles. The present article is expert views on the recent and historical literature available on the antifungal therapies with accessing their impact on the human health. Emphasis is given to the utility of the echinocandins a potental antifungal agent by discussing recent examples of clinical and laboratory studies including the use of improved proteomics approaches to know a bit more about the interaction of human host and fungal pathogens.

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“…In addition, most of these drugs exert serious unwanted effects on the host, such as nephrotoxicity caused by amphotericin B (6), visual disturbances caused by voriconazole (7), and congestive heart failure caused by itraconazole (8). In addition, some of these drugs, such as the echinocandins, are in limited clinical use due to high costs (9). Of particular importance today is the emergence of several Candida species resistant to many commonly used antifungal drugs, especially fluconazole (3,10).…”

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confidence: 99%