The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study

Collection Location Koleksi E-book & E-Journal Perpustakaan Pusat Unila
Edition Vol. 37, Issue. 12
Call Number
ISBN/ISSN 1435-4373
Author(s) Ghanem-Zoubi, Nesrin...[et al.]
Subject(s) Biomedicine
Classification NONE
Series Title
GMD E-Journal
Language English
Publisher Springer
Publishing Year 2018
Publishing Place Switzerland
Abstract/Notes Abstract
To evaluate the association between appropriate antifungal treatment and mortality among patients with candidemia using
different breakpoint definitions. In a retrospective study, we included all adults with candidemia in a tertiary center between
2009 and 2015. We defined three versions of appropriate (covering) antifungal treatment, according to Clinical and Laboratory
Standards Institute (CLSI) 2008, CLSI 2012, and European Committee on Antimicrobial Susceptibility Testing (EUCAST)
(2017 update) breakpoints. For empiric treatment, we evaluated the association with 30-day mortality. For definitive treatment,
we evaluated the association with 90-day mortality among patients surviving the first week after candidemia onset. Adjusted odds
ratios (OR) from a bivariate logistic regression with 95% confidence intervals are reported. We identified 302 patients with 308
separate candidemia episodes. The crude 30-day mortality was 55%(168/308). Resistance to anidulafungin increased from 3.5 to
51.6% and to fluconazole from 15.2 to 44.1%, when applying CLSI 2008 and EUCAST definitions, respectively. Appropriate
empirical treatment was significantly associated with lower 30-day mortality using the CLSI 2008 definitions, adjusted OR 0.56
(0.33–0.96). The associations were similar, though not statistically significant for EUCAST, 0.58 (0.33–1.00), and CLSI 2012,
OR 0.62 (0.37–1.04). Appropriate definitive treatment according to CLSI 2012 and EUCASTwas independently associated with
lower 90-day mortality, ORs 0.31 (0.13–0.75) and 0.44 (0.23–0.8), respectively.With CLSI 2008, the association was similar but
not statistically significant, OR 0.4 (0.11–1.41), with few isolates classified as resistant. Considering the major shift in resistance
prevalence when applying CLSI 2008, CLSI 2012, and EUCAST breakpoint definitions, no major differences were observed in
their association with mortality.
Keywords Candidemia . Breakpoints . Antifungal . Mortality . EUCAST . CLSI
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