Echinocandins versus Amphotericin B Against Candida tropicalis Fungemia in Adult Hematological Patients with Neutropenia: A Multicenter Retrospective Cohort Study

Figures & data

Table 1 Demographics, Clinical Characteristics, Antifungal Susceptibility, Treatment, and Outcome

Variables	N=90
Patient-related baseline
Age, years, mean (SD)	45.4 (16.1)
Gender, male n (%)	52 (57.8)
Acute leukemia n (%)	75 (83.3)
Others n (%)	15 (16.7)
Stem cell transplantation n (%)	11 (12.2)
Hospital duration days, mean (SD)	19.0 (9.0)
Duration days of neutropenia, mean (SD)	17.0 (10.8)
CVC n (%)	53 (58.9)
Removing CVC n (%)	12/53 (22.6)
Positive of CVC culture n (%)	1/12 (8.3)
Urinary catheter n (%)	5 (5.6)
Colonization n (%)	3 (3.3)
Renal dysfunction n (%)	3 (3.3)
Hepatic dysfunction n (%)	12 (13.3)
Fever n (%)	87 (96.7)
High fever n (%)	49 (54.4)
Vomit or diarrhea before candidemia n (%)	14 (15.6)
Concomitant diseases
Chronic pulmonary disease	1 (1.1)
Chronic cardiac insufficiency	3 (3.3)
Diabetes mellitus	4 (4.4)
Antifungal susceptibility
Resistant to azole n/N (%)*	51/85 (60.0)
Resistant to amphotericin B n/N (%)	0/85 (0.0)
Resistant to echinocandin n/N (%)	0/85 (0.0)
Treatments
Azole n (%)	27 (30.0)
Echinocandins n (%)	28 (31.1)
Amphotericin B n (%)	13 (14.4)
Amphoterin B and echinocandin n (%)	22 (24.4)
Outcomes
Death before day 8 n (%)	20 (22.2)
Death before day 30 n (%)	30 (33.3)

Notes: The data are presented as mean ± SD, or frequency with percentage (%). A temperature of >39°C was defined as high fever. *The five isolates susceptibility test could not be collected.

Abbreviations: SD, standard deviation; CVC, central venous catheter.

Table 2 Univariate Analysis of the Risk Factors and Outcomes

Variables	Death Before Day 8					Death Before Day 30
	Alive(n=70)		Dead(n=20)		P	Alive(n=60)		Dead(n=30)		P
	No	%	No	%		No	%	No	%
Patient-related baseline
Age, years, mean(SD)	70	44.4(16.6)	20	49.2(14.2)	0.238	60	43.7(15.7)	30	49(16.6)	0.139
Male sex	41	58.6	11	55	0.762	34	56.7	18	60	0.741
Female sex	29	41.4	9	45		26	43.3	12	40
Acute leukemia	58	82.9	17	85	1.000	52	86.7	23	76.7	0.254
Stem cell transplantation	8	11.4	3	15	0.710	8	13.3	3	10	0.766
Hospital duration days, mean(SD)	70	18.3(8.2)	20	21.6(11.0)	0.148	60	18.2(8.3)	30	20.8(10.1)	0.196
Neutropenia	66	94.3	19	95	1.000	57	95.0	28	93.3	0.661
CVC	41	58.6	12	60	0.903	35	58.3	18	60	0.868
Removing CVC	11	26.8	1	8.3	0.282	10	28.6	2	11.1	0.220
Urinary catheter	1	1.4	2	10	0.077	1	1.7	2	6.7	0.179
Colonization	4	5.7	1	5	1.000	3	5.0	2	6.7	0.661
Renal dysfunction	1	1.4	2	10	0.077	1	1.7	2	6.7	0.179
Hepatic dysfunction	8	11.4	4	20	0.282	6	10.0	6	20	0.204
Fever	67	95.7	20	100	1.000	57	95.0	30	100	0.600
High fever	38	54.3	11	55	0.952	32	53.3	17	56.7	0.743
Vomit or diarrhea before candidemia	10	14.3	4	20	0.507	9	15.0	5	16.7	0.782
Concomitant diseases
Chronic pulmonary disease	1	1.4	0	0	1.000	0	0	1	3.3	0.200
Chronic cardiac insufficiency	1	1.4	2	10	0.077	1	1.7	2	6.7	0.179
Diabetes mellitus	1	1.4	3	15	0.014	1	1.7	3	10	0.055
Antifungal susceptibility and treatment
Azole resistance (n=51)	38	56.7	13	72.2	0.210	32	56.1	19	67.9	0.260
Azole	15	21.4	12	60	0.000	11	18.3	15	50	0.002
Echinocandins	21	30	7	35	0.650	17	28.3	11	36.7	0.600
Amphotericin B	13	18.6	0	0	0.046	13	21.7	0	0	0.025
Amphoterin B and echinocandin	21	30	1	5	0.018	19	31.7	3	10.0	0.016

Note: The numbers in bold font mean p values are less than 0.05.

Abbreviations: SD, standard deviation; CVC, central venous catheter.

Figure 1 Comparison of clinical outcomes between different initial antifungal treatments. (A) The survival rates for day 8. Compared to the Ech group, a trend of superior survival could be observed in AmB-containing groups on day 8. (B) The survival rates for day 30. Patients who received AmB-containing antifungal treatment had a better survival rate than other patients on day 30 (AmB vs Ech: 100% vs 60.7%, P=0.024; AmB plus Ech vs Ech: 86.4% vs 60.7%, P=0.039; AmB vs AZL: 100% vs 40.7%, P=0.000).

Abbreviations: AZL, azoles; Ech, echinocandins; AmB, amphotericin B.

Figure 2 Azole resistance and outcomes. (A) The relationship between azole exposure and azole resistance. The azole resistance rate of isolates with azole exposure was significantly higher than those with no azole exposure before candidemia (90.3% vs 42.6%, P=0.000). (B and C) Comparison of clinical outcomes between azole-resistance and azole-sensitive groups on day 8 (B) and day 30 (C). Although a trend towards inferior survival could be observed in the azole-resistance group on day 8 and 30, the difference was not statistically significant.

Abbreviations: AZL, azoles; Ech, echinocandins; AmB, amphotericin B; Pro, prophylaxis.