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Article

Impact of select risk factors on treatment outcome in adults with candidemia

Brandon Hill1, Richard H. Drew2,3, Dustin Wilson2,3

  1. 1Department of Pharmacy Clinical Services, University of Virginia Medical Center, Charlottesville, VA, United States.
  2. 2Department of Pharmacy Practice, College of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, United States.
  3. 3Department of Pharmacy, Duke University Hospital, Durham, NC, United States.

Received: 17-05-2019; Accepted: 11-08-2019.

Volume 17, Issue 3 · pp. 1561 · PUBLISHED 21 August 2019 · DOI: 10.18549/PharmPract.2019.3.1561

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ABSTRACT

Background: Studies examining relationships between patient-related factors and treatment outcome in patients with candidemia are limited and often based on all-cause mortality. Objective: Our purpose was to examine the impact of concurrent renal replacement therapy (RRT) and other pre-specified factors on treatment outcome among adults with candidemia. Methods: This Institutional Review Board (IRB)-approved, single-center, case-cohort study included patients over 18 years of age admitted to Duke University Hospital between Jun 1, 2013 and Jun 1, 2017 with a blood culture positive for Candida spp. Treatment-, patient-, and disease-specific data were collected, and outcome (success/failure) determined 90 days after the index culture. An odds ratio (OR) and 95% confidence interval (95%CI) were calculated for the following during therapy: receipt of RRT, fluconazole monotherapy regimen, intensive care unit (ICU) stay, and neutropenia. Results: Among the 112 encounters (from 110 unique patients) included, treatment failure occurred in 8/112 (7.1%). Demographics were comparable between outcome groups. Among 12 patients receiving concomitant RRT, only 1 patient failed therapy. With regard to treatment failure, no significant differences were observed with RRT (OR, 1.21; 95%CI, 0.14 – 10.75), fluconazole monotherapy regimen (OR, 1.59; 95%CI, 0.3-8.27), ICU stay (OR, 1.43; 95%CI, 0.32-6.29), and neutropenia (0 treatment failures). Conclusions: Treatment failure, receipt of concomitant RRT, and neutropenia were infrequent in patients undergoing treatment for candidemia. In our cohort, exposure to RRT, a fluconazole monotherapy regimen, ICU stay, or neutropenia during treatment did not impact treatment outcome.

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    Hill, B., Drew, R. H., & Wilson, D. (2019). Impact of select risk factors on treatment outcome in adults with candidemia. Pharmacy Practice, 17(3), 1561. https://doi.org/10.18549/PharmPract.2019.3.1561