Short Course of Antifungal Therapy in Patients With Uncomplicated Candida Bloodstream Infection: Another Case of Less Is More in the Clinical Setting?

Abstract

Background To compare the clinical outcomes of patients receiving short course (SC) or prolonged course (PC) of antifungal therapy for uncomplicated Candida bloodstream infections (BSI). Methods All episodes of uncomplicated Candida BSI from 1 September 2018 to 31 August 2020 were reviewed. We compared the primary (all cause 90-day mortality) and secondary study endpoints (1-year recurrent Candida BSI and all-cause 1-year-mortality) among patients who underwent SC (5-11 days) or PC (12-24 days) therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results A total of 114 patients with uncomplicated Candida BSI were included: 35 (30.7%) were classified into the SC-group [median of 9 days (IQR 7-11 days)] and 79 (69.3%) into the PC-group [median of 14 days (IQR 14-16 days)]. Patients in SC-group compared to PC-group had a higher rate of hospitalization in the surgical ward (40.0% vs 19.0%, p = 0.02), or septic shock at the time of Candida BSI onset (11.4% vs 1.3%; p = 0.03). The risk of 90 day-mortality was not different between SC and PC groups [n = 8 (22.9%) vs 17 (21.5%), respectively; IPTW-adjusted sHR = 0.67; 95% CI = 0.31-1.47, P = 0.20]. The risk for recurrent Candida BSI within 1 year of completing therapy (IPTW-adjusted sHR = 1.07; 95% CI = 0.20-5.80, p = 0.94) or for all cause 1-year mortality (IPTW-adjusted HR = 0.72; 95% CI = 0.35-1.50, p = 0.38) did not differ between groups. Conclusions Short or prolonged course of antifungal therapy do not affect mortality and BSI recurrence in patients with uncomplicated candidemia.

Short Course Antibiotic Therapy for Catheter-Related Septic Thrombosis: “Caveat Emptor!”: Duration of Therapy Should Not Be Set a Priori

“…As for candidemia, adherence to international recommendations outlined in the EQUAL Candida score, representing a management bundle, is an independent predictor of survival [18]. Nevertheless, the boundary between complicated and uncomplicated forms is somewhat porous [3]; although, the absence of metastatic foci and of deep-seated candidiasis may be considered as a marker of a not-complicated infection [19].…”

“…Bloodstream infections (BSIs) represent no exception, and for instance, there is a growing body of evidence showing no significant difference in clinical outcomes comparing patients with uncomplicated Gram-negative BSI allocated to receive 7 days and the ones assigned to receive 14 days in randomized clinical trials (RCTs) [2]. Even in uncomplicated candidemia some authors advocated a shorter course than the usual 14 days after the first negative follow-up blood culture (FUBC) relying on a retrospective study [3]. From analogous evidence, other researchers suggested that in uncomplicated Staphyloccocus aureus BSI, namely the paradigmatic form of bacteremia with metastatic potential, less than 14 days of therapy may suffice according to real-world evidence (RWE) data [4].…”