Contributors: Institut de Chimie et Biochimie Moléculaires et Supramoléculaires (ICBMS); Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-École Supérieure de Chimie Physique Électronique de Lyon (CPE)-Institut National des Sciences Appliquées de Lyon (INSA Lyon); Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut de Chimie - CNRS Chimie (INC-CNRS)-Centre National de la Recherche Scientifique (CNRS); Hospices Civils de Lyon (HCL); Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL); Centre Léon Bérard Lyon -Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS); STMicroelectronics Crolles (ST-CROLLES); Hôpital de la Croix-Rousse CHU - HCL; Service d'Anesthésie-Réanimation, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; parent; Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN); Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon); Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); Service d'anesthésie-réanimation Centre Hospitalier Lyon Sud - HCL; Centre Hospitalier Lyon Sud CHU - HCL (CHLS); Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL); Laboratoire des pathogènes émergents -- Emerging Pathogens Laboratory CIRI (LPE-Fondation Mérieux); Centre International de Recherche en Infectiologie (CIRI); École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL); Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS); Service de parasitologie et mycologie médicale Hôpital de la Croix Rousse, Lyon; Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Service de Maladies Infectieuses et Tropicales Hôpital de la Croix-Rousse - HCL; Hôpital Edouard Herriot, Service Anesthésie Réanimation; Hôpital Edouard Herriot CHU - HCL; Service Pharmacie, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; We thank the Antifungal group, the Anti-Infective Committee, and the Committee for Medicinal Products and Medical Devices of Lyon University Hospital.
نبذة مختصرة : International audience ; BACKGROUND: Candidemia is a major cause of mortality in the intensive care unit (ICU). According to the Infectious Diseases Society of America (IDSA), an echinocandin is recommended as initial therapy and fluconazole as an alternative. In a context of echinocandin resistance development, the question arising is whether azoles are a suitable alternative to echinocandins for the treatment of candidemia in critically ill patients. METHODS: A 3-year (2015-2017) retrospective multicentric cohort study was conducted. Adult patients with a diagnosis of candidemia during the ICU stay and treated with echinocandins or azoles were included. Demographic, clinical data, mycological data, and antifungal treatments were collected. Kaplan-Meier survival analysis, univariate analysis, and a multivariate logistic regression analysis using a propensity score with the inverse probability of treatment weighting method were performed. FINDINGS: Seventy-nine patients (n = 79) were analyzed. Treatment success, as well as survival on day 90 (Kaplan-Meier survival analysis, log rank test, p = 0.542), were comparable between patients who received echinocandins (caspofungin (n = 47)) or azoles (fluconazole (n = 29) or voriconazole (n = 3)). A multivariable analysis demonstrated that higher SOFA score on the day of candidemia diagnosis and absence of adequate Candida source control were independently associated with a greater risk of 90-day mortality, whereas azoles treatment was not associated with an excess 90-day mortality. INTERPRETATION: This study confirms that the use of azoles recommended for candidemia, mostly fluconazole, as a first-line therapy is a reasonable alternative to caspofungin for ICU patients in our institution. This needs to be included in local guidelines through antifungal stewardship programs.
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