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

Abstract

Background: Candida tropicalis is the most common non-albicans Candida species identified in immunocompromised patients, which often appears with high mortality. However, data on the outcomes of treatment for Candida tropicalis fungemia in patients with neutropenia remain limited. Methods: In the present study, 90 neutropenic adult patients with proven Candida tropicalis fungemia, who received initial antifungal therapy, were retrospectively analyzed. Results: These results revealed that the overall 8-day and 30-day mortality among patients in the entire data set were 22.2% and 33.3%, respectively. However, there was no significant difference between the survival and death group, in terms of baseline characteristics. The univariate analysis of risk factors identified the treatment with azole as a predictor of mortality, while treatments that containing amphotericin B were associated with reduced mortality. In addition, the survival rate on day 30 was observed in 60.7% (17/28) of patients who were initially treated with echinocandins, while this was observed in 86.4% (19/22, P=0.039) and 100% (13/13, P=0.024) of patients treated with amphotericin B plus echinocandins and amphotericin B, respectively. Conclusion: These data indicate for the first time that the initial therapy with amphotericin B-based agents was associated with a better survival rate and could be assessed as the optimal strategy for the treatment of Candida tropicalis fungemia in patients with neutropenia.

Candida tropicalis—A systematic review to inform the World Health Organization of a fungal priority pathogens list

“… 1 , 21 Five studies reported on the 30-day mortality rates in C. tropicalis candidaemia patients ranging from 32% to 52%. 2 , 10 , 11 , 22 , 23 Overall mortality rates in paediatric patients with invasive C. tropicalis infections were 26%–40%. 24 , 25 …”

A determination of pan-pathogen antimicrobials?

“…The past 15 years have seen an acceleration in antifungal drug development, culminating in an armamentarium of systemic antifungal agents including 5 classes of drugs including amphotericin B (AmB), the azoles, and the echinocandins [41] . Although their in vitro inhibitory and direct fungicidal effects are well characterised, antifungals also have indirect, immune system-mediated effects on fungi, which are only now coming to light [42] .…”

A New Determination of Pan-Pathogen Antimicrobials

“…The past 15 years have seen an acceleration in antifungal drug development, culminating in an armamentarium of systemic antifungal agents including 5 classes of drugs including amphotericin B (AmB), the azoles, and the echinocandins 35 . Although their in vitro inhibitory and direct fungicidal effects are well characterised, antifungals also have indirect, immune system-mediated effects on fungi, which are only now coming to light 36 .…”