The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study
To evaluate the association between appropriate antifungal treatment and mortality among patients with candidemia using different breakpoint definitions. In a retrospective study, we included all adults with candidemia in a tertiary center between 2009 and 2015. We defined three versions of appropri...
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| Veröffentlicht in: | European journal of clinical microbiology & infectious diseases 2018-12, Vol.37 (12), p.2397-2404 |
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| creator | Ghanem-Zoubi, Nesrin Zorbavel, Danny Khoury, Johad Geffen, Yuval Qasum, Majd Predescu, Svetlana Paul, Mical |
| description | To evaluate the association between appropriate antifungal treatment and mortality among patients with candidemia using different breakpoint definitions. In a retrospective study, we included all adults with candidemia in a tertiary center between 2009 and 2015. We defined three versions of appropriate (covering) antifungal treatment, according to Clinical and Laboratory Standards Institute (CLSI) 2008, CLSI 2012, and European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2017 update) breakpoints. For empiric treatment, we evaluated the association with 30-day mortality. For definitive treatment, we evaluated the association with 90-day mortality among patients surviving the first week after candidemia onset. Adjusted odds ratios (OR) from a bivariate logistic regression with 95% confidence intervals are reported. We identified 302 patients with 308 separate candidemia episodes. The crude 30-day mortality was 55% (168/308). Resistance to anidulafungin increased from 3.5 to 51.6% and to fluconazole from 15.2 to 44.1%, when applying CLSI 2008 and EUCAST definitions, respectively. Appropriate empirical treatment was significantly associated with lower 30-day mortality using the CLSI 2008 definitions, adjusted OR 0.56 (0.33–0.96). The associations were similar, though not statistically significant for EUCAST, 0.58 (0.33–1.00), and CLSI 2012, OR 0.62 (0.37–1.04). Appropriate definitive treatment according to CLSI 2012 and EUCAST was independently associated with lower 90-day mortality, ORs 0.31 (0.13–0.75) and 0.44 (0.23–0.8), respectively. With CLSI 2008, the association was similar but not statistically significant, OR 0.4 (0.11–1.41), with few isolates classified as resistant. Considering the major shift in resistance prevalence when applying CLSI 2008, CLSI 2012, and EUCAST breakpoint definitions, no major differences were observed in their association with mortality. |
| doi_str_mv | 10.1007/s10096-018-3389-1 |
| format | Article |
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In a retrospective study, we included all adults with candidemia in a tertiary center between 2009 and 2015. We defined three versions of appropriate (covering) antifungal treatment, according to Clinical and Laboratory Standards Institute (CLSI) 2008, CLSI 2012, and European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2017 update) breakpoints. For empiric treatment, we evaluated the association with 30-day mortality. For definitive treatment, we evaluated the association with 90-day mortality among patients surviving the first week after candidemia onset. Adjusted odds ratios (OR) from a bivariate logistic regression with 95% confidence intervals are reported. We identified 302 patients with 308 separate candidemia episodes. The crude 30-day mortality was 55% (168/308). Resistance to anidulafungin increased from 3.5 to 51.6% and to fluconazole from 15.2 to 44.1%, when applying CLSI 2008 and EUCAST definitions, respectively. Appropriate empirical treatment was significantly associated with lower 30-day mortality using the CLSI 2008 definitions, adjusted OR 0.56 (0.33–0.96). The associations were similar, though not statistically significant for EUCAST, 0.58 (0.33–1.00), and CLSI 2012, OR 0.62 (0.37–1.04). Appropriate definitive treatment according to CLSI 2012 and EUCAST was independently associated with lower 90-day mortality, ORs 0.31 (0.13–0.75) and 0.44 (0.23–0.8), respectively. With CLSI 2008, the association was similar but not statistically significant, OR 0.4 (0.11–1.41), with few isolates classified as resistant. Considering the major shift in resistance prevalence when applying CLSI 2008, CLSI 2012, and EUCAST breakpoint definitions, no major differences were observed in their association with mortality.</description><identifier>ISSN: 0934-9723</identifier><identifier>EISSN: 1435-4373</identifier><identifier>DOI: 10.1007/s10096-018-3389-1</identifier><identifier>PMID: 30284179</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adults ; Aged ; Antifungal Agents - therapeutic use ; Biomedical and Life Sciences ; Biomedicine ; Bivariate analysis ; Breakpoints ; Candida - isolation & purification ; Candidemia ; Candidemia - drug therapy ; Candidemia - mortality ; Confidence intervals ; Drug Resistance, Fungal ; Female ; Fluconazole ; Fluconazole - therapeutic use ; Fungicides ; Health risk assessment ; Humans ; Internal Medicine ; Logistic Models ; Male ; Medical Microbiology ; Microbial Sensitivity Tests ; Middle Aged ; Mortality ; Observational studies ; Odds Ratio ; Original Article ; Patients ; Retrospective Studies ; Statistical analysis ; Statistical significance ; Treatment Outcome</subject><ispartof>European journal of clinical microbiology & infectious diseases, 2018-12, Vol.37 (12), p.2397-2404</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>European Journal of Clinical Microbiology & Infectious Diseases is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-99f2fe998921f1f05d2f5d53c7b68025bb1c824016ac7013840070ea8b8b610b3</citedby><cites>FETCH-LOGICAL-c372t-99f2fe998921f1f05d2f5d53c7b68025bb1c824016ac7013840070ea8b8b610b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10096-018-3389-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10096-018-3389-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30284179$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ghanem-Zoubi, Nesrin</creatorcontrib><creatorcontrib>Zorbavel, Danny</creatorcontrib><creatorcontrib>Khoury, Johad</creatorcontrib><creatorcontrib>Geffen, Yuval</creatorcontrib><creatorcontrib>Qasum, Majd</creatorcontrib><creatorcontrib>Predescu, Svetlana</creatorcontrib><creatorcontrib>Paul, Mical</creatorcontrib><title>The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study</title><title>European journal of clinical microbiology & infectious diseases</title><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><description>To evaluate the association between appropriate antifungal treatment and mortality among patients with candidemia using different breakpoint definitions. In a retrospective study, we included all adults with candidemia in a tertiary center between 2009 and 2015. We defined three versions of appropriate (covering) antifungal treatment, according to Clinical and Laboratory Standards Institute (CLSI) 2008, CLSI 2012, and European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2017 update) breakpoints. For empiric treatment, we evaluated the association with 30-day mortality. For definitive treatment, we evaluated the association with 90-day mortality among patients surviving the first week after candidemia onset. Adjusted odds ratios (OR) from a bivariate logistic regression with 95% confidence intervals are reported. We identified 302 patients with 308 separate candidemia episodes. The crude 30-day mortality was 55% (168/308). Resistance to anidulafungin increased from 3.5 to 51.6% and to fluconazole from 15.2 to 44.1%, when applying CLSI 2008 and EUCAST definitions, respectively. Appropriate empirical treatment was significantly associated with lower 30-day mortality using the CLSI 2008 definitions, adjusted OR 0.56 (0.33–0.96). The associations were similar, though not statistically significant for EUCAST, 0.58 (0.33–1.00), and CLSI 2012, OR 0.62 (0.37–1.04). Appropriate definitive treatment according to CLSI 2012 and EUCAST was independently associated with lower 90-day mortality, ORs 0.31 (0.13–0.75) and 0.44 (0.23–0.8), respectively. With CLSI 2008, the association was similar but not statistically significant, OR 0.4 (0.11–1.41), with few isolates classified as resistant. Considering the major shift in resistance prevalence when applying CLSI 2008, CLSI 2012, and EUCAST breakpoint definitions, no major differences were observed in their association with mortality.</description><subject>Adults</subject><subject>Aged</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Bivariate analysis</subject><subject>Breakpoints</subject><subject>Candida - isolation & purification</subject><subject>Candidemia</subject><subject>Candidemia - drug therapy</subject><subject>Candidemia - mortality</subject><subject>Confidence intervals</subject><subject>Drug Resistance, Fungal</subject><subject>Female</subject><subject>Fluconazole</subject><subject>Fluconazole - therapeutic use</subject><subject>Fungicides</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical Microbiology</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Odds Ratio</subject><subject>Original Article</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Statistical significance</subject><subject>Treatment Outcome</subject><issn>0934-9723</issn><issn>1435-4373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kctu1DAUhi0EokPhAdggS2y6CfiSxDa7atSWSiOx6HQd2c5J65LYwXZazTvxkHhmCkhIbHwkn-8_tx-h95R8ooSIz6m8qq0IlRXnUlX0BVrRmjdVzQV_iVZE8bpSgvET9CalB1I0UojX6IQTJmsq1Ar93N4D1ikF63R2wWMD-QnA4xxB5wl8xnqeY5hjyYOHlLC2NsTe-TucA764XZ_fbLH2PV5vbq6xKbLvc3A-p8PnFGLWo8s7rKdQJHPpAvvkk8v32BbE9TA5_QVrHCHHkGaw2T0CDiZBfDwMpUec8tLv3qJXgx4TvHuOp-j28mK7_lptvl1dr883leWC5UqpgQ2glFSMDnQgTc-Gpm-4FaaVhDXGUCtZTWirrSCUy7ochoCWRpqWEsNP0dmxbln8xwIpd5NLFsZRewhL6hilLaWiVrKgH_9BH8ISy8QHqikTtIQUih4pWxZMEYau3HPScddR0u2t7I5WdsXKbm9lR4vmw3PlxUzQ_1H89q4A7AikkvJ3EP-2_n_VX56urBA</recordid><startdate>20181201</startdate><enddate>20181201</enddate><creator>Ghanem-Zoubi, Nesrin</creator><creator>Zorbavel, Danny</creator><creator>Khoury, Johad</creator><creator>Geffen, Yuval</creator><creator>Qasum, Majd</creator><creator>Predescu, Svetlana</creator><creator>Paul, Mical</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20181201</creationdate><title>The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study</title><author>Ghanem-Zoubi, Nesrin ; Zorbavel, Danny ; Khoury, Johad ; Geffen, Yuval ; Qasum, Majd ; Predescu, Svetlana ; Paul, Mical</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-99f2fe998921f1f05d2f5d53c7b68025bb1c824016ac7013840070ea8b8b610b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adults</topic><topic>Aged</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Bivariate analysis</topic><topic>Breakpoints</topic><topic>Candida - isolation & purification</topic><topic>Candidemia</topic><topic>Candidemia - drug therapy</topic><topic>Candidemia - mortality</topic><topic>Confidence intervals</topic><topic>Drug Resistance, Fungal</topic><topic>Female</topic><topic>Fluconazole</topic><topic>Fluconazole - therapeutic use</topic><topic>Fungicides</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical Microbiology</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Odds Ratio</topic><topic>Original Article</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Statistical significance</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ghanem-Zoubi, Nesrin</creatorcontrib><creatorcontrib>Zorbavel, Danny</creatorcontrib><creatorcontrib>Khoury, Johad</creatorcontrib><creatorcontrib>Geffen, Yuval</creatorcontrib><creatorcontrib>Qasum, Majd</creatorcontrib><creatorcontrib>Predescu, Svetlana</creatorcontrib><creatorcontrib>Paul, Mical</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of clinical microbiology & infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghanem-Zoubi, Nesrin</au><au>Zorbavel, Danny</au><au>Khoury, Johad</au><au>Geffen, Yuval</au><au>Qasum, Majd</au><au>Predescu, Svetlana</au><au>Paul, Mical</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study</atitle><jtitle>European journal of clinical microbiology & infectious diseases</jtitle><stitle>Eur J Clin Microbiol Infect Dis</stitle><addtitle>Eur J Clin Microbiol Infect Dis</addtitle><date>2018-12-01</date><risdate>2018</risdate><volume>37</volume><issue>12</issue><spage>2397</spage><epage>2404</epage><pages>2397-2404</pages><issn>0934-9723</issn><eissn>1435-4373</eissn><abstract>To evaluate the association between appropriate antifungal treatment and mortality among patients with candidemia using different breakpoint definitions. In a retrospective study, we included all adults with candidemia in a tertiary center between 2009 and 2015. We defined three versions of appropriate (covering) antifungal treatment, according to Clinical and Laboratory Standards Institute (CLSI) 2008, CLSI 2012, and European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2017 update) breakpoints. For empiric treatment, we evaluated the association with 30-day mortality. For definitive treatment, we evaluated the association with 90-day mortality among patients surviving the first week after candidemia onset. Adjusted odds ratios (OR) from a bivariate logistic regression with 95% confidence intervals are reported. We identified 302 patients with 308 separate candidemia episodes. The crude 30-day mortality was 55% (168/308). Resistance to anidulafungin increased from 3.5 to 51.6% and to fluconazole from 15.2 to 44.1%, when applying CLSI 2008 and EUCAST definitions, respectively. Appropriate empirical treatment was significantly associated with lower 30-day mortality using the CLSI 2008 definitions, adjusted OR 0.56 (0.33–0.96). The associations were similar, though not statistically significant for EUCAST, 0.58 (0.33–1.00), and CLSI 2012, OR 0.62 (0.37–1.04). Appropriate definitive treatment according to CLSI 2012 and EUCAST was independently associated with lower 90-day mortality, ORs 0.31 (0.13–0.75) and 0.44 (0.23–0.8), respectively. With CLSI 2008, the association was similar but not statistically significant, OR 0.4 (0.11–1.41), with few isolates classified as resistant. Considering the major shift in resistance prevalence when applying CLSI 2008, CLSI 2012, and EUCAST breakpoint definitions, no major differences were observed in their association with mortality.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30284179</pmid><doi>10.1007/s10096-018-3389-1</doi><tpages>8</tpages></addata></record> |
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| ispartof | European journal of clinical microbiology & infectious diseases, 2018-12, Vol.37 (12), p.2397-2404 |
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| subjects | Adults Aged Antifungal Agents - therapeutic use Biomedical and Life Sciences Biomedicine Bivariate analysis Breakpoints Candida - isolation & purification Candidemia Candidemia - drug therapy Candidemia - mortality Confidence intervals Drug Resistance, Fungal Female Fluconazole Fluconazole - therapeutic use Fungicides Health risk assessment Humans Internal Medicine Logistic Models Male Medical Microbiology Microbial Sensitivity Tests Middle Aged Mortality Observational studies Odds Ratio Original Article Patients Retrospective Studies Statistical analysis Statistical significance Treatment Outcome |
| title | The association between treatment appropriateness according to EUCAST and CLSI breakpoints and mortality among patients with candidemia: a retrospective observational study |
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