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Usefulness of guideline recommendations for prognosis in patients with candidemia

We aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine speci...

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Published in:Medical mycology (Oxford) 2019-08, Vol.57 (6), p.659-667
Main Authors: Cuervo, Guillermo, Garcia-Vidal, Carolina, Puig-Asensio, Mireia, Merino, Paloma, Vena, Antonio, Martín-Peña, Almudena, Montejo, José Miguel, Ruiz, Alba, Lázaro-Perona, Fernando, Fortún, Jesús, Fernández-Ruiz, Mario, Suarez, Ana Isabel, Castro, Carmen, Cardozo, Celia, Gudiol, Carlota, Aguado, José María, Paño, Jose Ramón, Pemán, Javier, Salavert, Miquel, Garnacho-Montero, José, Cisneros, José Miguel, Soriano, Alex, Muñoz, Patricia, Almirante, Benito, Carratalà, Jordi
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cited_by cdi_FETCH-LOGICAL-c287t-14e28a05adcb5bbb7e8138809c7ff70840379d010b9a404bcaa68f13e1c80b443
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container_end_page 667
container_issue 6
container_start_page 659
container_title Medical mycology (Oxford)
container_volume 57
creator Cuervo, Guillermo
Garcia-Vidal, Carolina
Puig-Asensio, Mireia
Merino, Paloma
Vena, Antonio
Martín-Peña, Almudena
Montejo, José Miguel
Ruiz, Alba
Lázaro-Perona, Fernando
Fortún, Jesús
Fernández-Ruiz, Mario
Suarez, Ana Isabel
Castro, Carmen
Cardozo, Celia
Gudiol, Carlota
Aguado, José María
Paño, Jose Ramón
Pemán, Javier
Salavert, Miquel
Garnacho-Montero, José
Cisneros, José Miguel
Soriano, Alex
Muñoz, Patricia
Almirante, Benito
Carratalà, Jordi
description We aimed to analyze whether the lack of inclusion of specific recommendations for the management of candidemia is an independent risk factor for early and overall mortality. Multicenter study of adult patients with candidemia in 13 hospitals. We assessed the proportion of patients on whom nine specific ESCMID and IDSA guidelines recommendations had been applied, and analyzed its impact on mortality. 455 episodes of candidemia were documented. Patients who died within the first 48 hours were excluded. Sixty-two percent of patients received an appropriate antifungal treatment. Either echinocandin or amphotericin B therapy were administered in 43% of patients presenting septic shock and in 71% of those with neutropenia. Sixty-one percent of patients with breakthrough candidemia underwent a change in antifungal drug class. Venous catheters were removed in 79% of cases. Follow-up blood cultures were performed in 72% of cases. Ophthalmoscopy and echocardiogram were performed in 48% and 50% of patients, respectively. Length of treatment was appropriate in 78% of cases. Early (2-7 days) and overall (2-30 days) mortality were 8% and 27.7%, respectively. Inclusion of less than 50% of the specific recommendations was independently associated with a higher early (HR = 7.02, 95% CI: 2.97-16.57; P < .001) and overall mortality (HR = 3.55, 95% CI: 2.24-5.64; P < .001). In conclusion, ESCMID and IDSA guideline recommendations were not performed on a significant number of patients. Lack of inclusion of these recommendations proved to be an independent risk factor for early and overall mortality.
doi_str_mv 10.1093/mmy/myy118
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title Usefulness of guideline recommendations for prognosis in patients with candidemia
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