Effect of antifungal therapy timing on mortality in cancer patients with candidemia Journal Article

Authors: Taur, Y.; Cohen, N.; Dubnow, S.; Paskovaty, A.; Seo, S. K.
Article Title: Effect of antifungal therapy timing on mortality in cancer patients with candidemia
Abstract: Prior studies have shown that delays in treatment are associated with increased mortality in patients with candidemia. The purpose of this study was to measure three separate time periods comprising the diagnosis and treatment of candidemia and to determine which one(s) is associated with hospital mortality. Patients with blood cultures positive for Candida spp. were identified. Subjects were excluded if no antifungal therapy was given or if there was preexisting antifungal therapy. Collected data included the time from blood culture collection to positivity (incubation period), the time from blood culture positivity to provider notification (provider notification period), and the time from provider notification to the first dose of antifungal given (antifungal initiation period). These times were assessed as predictors of inpatient mortality. A repeat analysis was done with adjustments for age, sex, race, underlying cancer, catheter removal, APACHE III score, acute renal failure, neutropenia, and non-Candida albicans species. A total of 106 episodes of candidemia were analyzed. The median incubation time was 32.1 h and was associated with mortality (univariate hazard ratio per hour, 1.025; P = 0.001). The median provider notification and antifungal initiation periods were 0.3 and 7.5 h, respectively, and were not associated with mortality. Adjusted analysis yielded similar results. For cancer patients with candidemia, the incubation period accounts for a significant amount of time, compared with the provider notification and antifungal initiation times, and is associated with in-hospital mortality. Strategies to shorten the incubation time, such as utilizing rapid molecularly based diagnostic methods, may help reduce in-hospital mortality. Copyright Ā© 2010, American Society for Microbiology. All Rights Reserved.
Keywords: adolescent; adult; child; controlled study; preschool child; school child; aged; aged, 80 and over; child, preschool; middle aged; retrospective studies; young adult; major clinical study; clinical feature; neoplasms; cohort studies; information processing; cancer mortality; blood; infant; newborn; multivariate analysis; bacterium identification; fluconazole; candidiasis; voriconazole; antifungal agents; echinocandin; hospital mortality; blood culture; candidemia; kidney failure, acute; amphotericin b lipid complex; apache; candida; incubation time
Journal Title: Antimicrobial Agents and Chemotherapy
Volume: 54
Issue: 1
ISSN: 0066-4804
Publisher: American Society for Microbiology  
Date Published: 2010-01-01
Start Page: 184
End Page: 190
Language: English
DOI: 10.1128/aac.00945-09
PUBMED: 19884371
PROVIDER: scopus
PMCID: PMC2798557
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 20 April 2011" - "CODEN: AMACC" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Susan Seo
    74 Seo
  2. Ying Taur
    101 Taur
  3. Sarah M Dubnow
    2 Dubnow