The impact of delaying the initiation of appropriate antifungal treatment for Candida bloodstream infection

Abstract

We performed a retrospective analysis of the time to initiation of appropriate antifungal therapy for candidemia and in-hospital mortality. The definition of appropriate antifungal therapy was based on in vitro susceptibility results, and in the case of fluconazole, pharmacodynamic parameters. Of 123 patients, the mortality rate in the <24 h, 24–48 h, and >48 h groups was 50%, 28%, and 32%, respectively. Patients who never received antifungal treatment had a 61% mortality rate (difference between groups, P =0.06). Multivariate analysis found APACHE II score (AOR = 1.09, 95% CI: 1.02–1.17 for each point increase) to be the only independent predictor of mortality. The time to initiation of appropriate antifungal therapy did not correlate with in-hospital mortality.

Keywords:

• candidemia
• fluconazole
• antifungals
• Candida
• initiation

Declaration of interest: The authors report no conflicts of interest. The authors alone \are responsible for the content and writing of the paper.

This paper was first published online on Early Online on 01 February 2010.