Evaluating predictors of invasive candidiasis in patients with and without candidemia on micafungin

Abstract

Numerous risk factors have been linked to invasive candidiasis; however, they are nonspecific and often trigger empiric antifungal therapy in a large number of patients. Identification of more precise predictors could promote judicious use of empiric echinocandins. In this retrospective review, 127 patients with blood cultures positive for Candida spp. were compared to a randomly selected cohort of 134 patients on empiric micafungin for 3 days and with blood cultures negative for Candida spp. Factors associated with candidemia included total parenteral nutrition (TPN; 26.0% vs 15.7%, P D 0.040), multifocal Candida colonization (23.6% vs 3.0%, P < 0.001), and positive 1,3-b-D-glucan assay (95.0% vs 35.0%, P < 0.001). Patients without candidemia on empiric micafungin were more likely to receive antibiotic therapy in the previous 10 days (55.9% vs 79.9%, P < 0.001) and to be taking immunosuppressive medications (11.0% vs 30.6%, P < 0.001). Receipt of TPN (odds ratio [OR] D 2.07, 95% confidence interval [CI], 1.02-4.21), severe sepsis (OR D 2.20, 95% CI, 1.00-4.83), and multifocal Candida colonization (OR D 13.87, 95% CI, 4.43-43.37) were independently associated with candidemia in the multivariable logistic regression model. Therefore, the absence of these risk factors, especially in conjunction with a negative 1,3-b-D-glucan assay, may be used to recommend de-escalation of empiric micafungin therapy.

Antifungal consumption trends in the adult intensive care unit of a university hospital in Bahia, Brazil

“…documented. [42][43][44] From the data in Figure 2, a reduction in the consumption of caspofungin was observed over the period, with an increase in the consumption of micafungin. Although there are differences in terms of in vitro antifungal activities, toxicity profile and pharmacokinetics, the relevance of these distinctions between drugs is minimal.…”

Prediction of candidemia in pediatric patients based on central venous catheter: Real world evidence to guide antifungal empirical prescription

“…Moreover, a study with an adult population achieved an AUC of 0.71 with TPN, severe sepsis, and multifocal Candida colonization as the significant predictors for their study center (Carr et al, 2018). However, the selection criteria for the control group in these studies are more comprehensive, considering only aspects such as length of stay ( Zaoutis, 2010;Zaoutis et al, 2010) and including patients without evidence of fungal infection (Zaoutis et al, 2004).…”

“…There are guidelines that recommend the use of scoring tools, such as the Candida score, and biomarkers such as β-Dglucan; however, the criteria for indication and duration of empirical antifungal therapy remains undetermined. Identification of more accurate predictors can promote the more judicious use of empirical antifungals (Carr, Colley, Berhe, & Nguyen, 2018;Keighley et al, 2021).…”

Pseudomembranous candidiasis by Candida tropicalis in an immunocompromised patient: Case Report.

“…Candidiasis refers in general terms to a superficial or deep infection of the skin, mucosa, or both, caused by members of the genus Candida, 1 which can occur at any age depending on risk factors such as diabetes mellitus, frequent use of antibiotics, behavioral factors, and immunosuppression. 2,3 The genus Candida has several virulence factors such as adhesion factors, the production of biofilms, and the production and secretion of proteolytic enzymes, enabling it to colonize and cause infection. 4,5 Oral candidiasis is a condition associated with the use of dental prostheses and patients with immunosuppression and it is mainly caused by Candida albicans, a Candida species with both a yeast and hypha morphology and accounts for more than 80% of oral fungal isolates 6 from both healthy and diseased persons.…”