Treatment of invasive candidiasis: between guidelines and daily clinical practice

Tagliaferri, Enrico; Menichetti, Francesco

doi:10.1586/14787210.2015.1029916

Cited by 12 publications

(7 citation statements)

References 40 publications

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“…The study by Heimann et al (2015) supported this finding; their study showed that the mean overall direct treatment costs per patient treated with an echinocandin to be significantly higher than fluconazole, the main contributor being that the echinocandin treated patients were unwell and had longer ICU stays. This is contrary to the findings from Tagliaferri and Menichetti (2015) who found that the echinocandins reduced the overall in-hospital costs compared to fluconazole, and Reboli et al (2011) who concluded that anidulafungin versus fluconazole in ICU patients resulted in a reduction in total IC related costs due to the decreased length of stay.…”

Section: Discussioncontrasting

confidence: 63%

Direct Treatment Costs of Invasive Candidiasis in Haematology Patients at a South African Private Hospital

Cruickshank¹,

Suleman²

2019

GJHS

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BACKGROUND: Haematology patients are at a high risk of developing invasive candidiasis (IC). Fluconazole has been the mainstay of prophylaxis and treatment with a newer class of therapeutic options, the echinocandins, having seen a considerable improvement in treatment success. However, these agents are associated with substantial acquisition costs when compared to fluconazole. OBJECTIVE: This study analysed the direct treatment costs of invasive candidiasis in haematology patients, comparing the costs between three groups depending on the treatment, namely, the fluconazole only group, the echinocandin only group or the group that was treated with both fluconazole and an echinocandin. To determine which variables contributed to the overall costs and whether there were differences between the groups. METHODS: This was a retrospective, single-centre economic analysis at a private hospital of patients with IC in the haematology ward in Durban, KwaZulu-Natal Province, South Africa. The direct medical costs related to managing IC were analysed. Adult patients (≥18 years old) diagnosed with a haematology disorder and a positive blood culture for Candida who were prescribed fluconazole and/or an echinocandin as treatment were included in the study. Patients treated with echinocandins, fluconazole or both classes of antifungals were analysed separately and compared. RESULTS: No statistically significant difference for duration of antifungal treatment or length of hospital stay between the three groups existed. Mean overall direct treatment costs per patient were: ZAR130 326 (95% CI: -4 932 – 265 584) for patients treated with fluconazole, ZAR241 165 (95% CI: 159 175 – 323 155) for patients receiving an echinocandin and ZAR270 802 (95% CI: 68 277 - 473 327) for patients treated with the combination CONCLUSION: The results of this cost analysis found that treatment with fluconazole only is considerably less expensive, almost half of the mean daily treatment cost, than an echinocandin only and treatment using both agents, is less expensive than an echinocandin only as first-line therapy.

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Section: Discussioncontrasting

confidence: 63%

Direct Treatment Costs of Invasive Candidiasis in Haematology Patients at a South African Private Hospital

Cruickshank¹,

Suleman²

2019

GJHS

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“…Candida albicans is an asexual opportunistic fungus that causes infections in immunocompromised and debilitated individuals[ 1 ]. Azole drugs are widely used in clinical practice having a good antibacterial power and low side effects[ 2 ]. Unfortunately, widespread uses of azole drugs have led to the rapid development of drug resistance which hampers the efficacy of current treatments for invasive mycoses.…”

Section: Introductionmentioning

confidence: 99%

Metabolomic profiling for the identification of potential biomarkers involved in a laboratory azole resistance in Candida albicans

Liao

et al. 2018

PLoS ONE

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Candida albicans, one of the most common fungal pathogens, is responsible for several yeast infections in human hosts, being resistant to classically used antifungal drugs, such as azole drugs. Multifactorial and multistep alterations are involved in the azole resistance in Candida albicans. In this study, a FCZ-resistant C. albicans strain was obtained by serial cultures of a FCZ-susceptible C. albicans strain in incrementally increasing concentrations of FCZ. We performed an integrated profile of different classes of molecules related to azole resistance in C. albicans by combining several mass-spectrometry based methodologies. The comparative metabolomic study was performed with the sensitive and resistant strains of C.albicans to identify metabolites altered during the development of resistance to fluconazole, while the intervention strains and non-intervention strains of C.albicans to identify metabolites altered involved in cross-resistant to azole drugs. Our analysis of the different metabolites identified molecules mainly involved in metabolic processes such as amino acid metabolism, tricarboxylic acid cycle and phospholipid metabolism. We also compared the phospholipid composition of each group, revealing that the relative content of phospholipids significantly changed during the development of resistance to azole drugs. According with these results, we hypothesized that the metabolism shift might contribute to azole drugs resistance in C.albicans from multifactorial alterations. Our result paves the way to understand processes underlying the resistance to azole drugs in C. albicans, providing the basis for developing new antifungal drugs.

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“…Due to the risk of high toxicity (nephrotoxicity), amphotericin B is no more considered as an option in the treatment. Lipid formulations of amphotericin B diminish the nephrotoxic effect, but are significantly more expensive than the well‐tolerated fluconazole and more toxic than echinocandins, hence its application is considered only in specific situations . As fluconazole is inexpensive and readily available worldwide, it is the most frequently prescribed triazole to treat Candida infections .…”

Section: Global Challenges In Treatment Of Candida Infectionsmentioning

confidence: 99%

“…Lipid formulations of amphotericin B diminish the nephrotoxic effect, but are significantly more expensive than the well-tolerated fluconazole and more toxic than echinocandins, hence its application is considered only in specific situations. [15] As fluconazole is inexpensive and readily available worldwide, it is the most frequently prescribed triazole to treat Candida infections. [16] However, voriconazole is more efficient than fluconazole, but considering the high therapeutic cost it is prescribed only when the infective Candida strain is fluconazole-resistant.…”

Section: Limitations In Clinical Therapymentioning

confidence: 99%

Cysteine‐Rich Antifungal Proteins from Filamentous Fungi are Promising Bioactive Natural Compounds in Anti‐Candida Therapy

Galgóczy

Yap

Marx

2019

Israel Journal of Chemistry

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The emerging number of life‐threatening invasive fungal infections caused by drug‐resistant Candida strains urges the need for the development and application of fundamentally new and safe antifungal strategies in the clinical treatment. Recent studies demonstrated that the extracellular cysteine‐rich and cationic antifungal proteins (crAFPs) originating from filamentous fungi, and de novo designed synthetic peptide derivatives of these crAFPs provide a feasible basis for this approach. This mini‐review focuses on the global challenges of the anti‐Canidia therapy and on the crAFPs as potential drug candidates to overcome existing problems. The advantages and limitations in the use of crAFPs and peptide derivatives compared to those of conventional antifungal drugs will also be critically discussed.

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Treatment of invasive candidiasis: between guidelines and daily clinical practice

Cited by 12 publications

References 40 publications

Direct Treatment Costs of Invasive Candidiasis in Haematology Patients at a South African Private Hospital

Direct Treatment Costs of Invasive Candidiasis in Haematology Patients at a South African Private Hospital

Metabolomic profiling for the identification of potential biomarkers involved in a laboratory azole resistance in Candida albicans

Cysteine‐Rich Antifungal Proteins from Filamentous Fungi are Promising Bioactive Natural Compounds in Anti‐Candida Therapy

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