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

Authors You L, Yao C, Yang F, Yang Q, Lan J, Song X, Shen J, Sheng X, Chen X, Tang H, Jiang H, Wu H, Qian S, Meng H

Received 18 April 2020

Accepted for publication 25 June 2020

Published 10 July 2020 Volume 2020:13 Pages 2229—2235

DOI https://doi.org/10.2147/IDR.S258744

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Suresh Antony


Liangshun You,1,* Cunying Yao,1,2,* Fan Yang,3 Qing Yang,4 Jianping Lan,5 Xiaolu Song,5 Jianping Shen,6 Xianfu Sheng,6 Xiaohui Chen,7 Huifen Tang,7 Huifang Jiang,8 Haiying Wu,8 Shenxian Qian,3 Haitao Meng1

1Department of Hematology, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People’s Republic of China; 2Department of Hematology, The Second Affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China; 3Department of Hematology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People’s Republic of China; 5Department of Hematology, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China; 6Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 7Department of Hematology, The Affiliated Hospital, Hangzhou Normal University, Hangzhou, People’s Republic of China; 8Department of Hematology, Tongde Hospital of Zhejiang Province, Hangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Haitao Meng; Shenxian Qian Email menghait2004@zju.edu.cn; sxqian@hotmail.com

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.

Keywords: Candida tropicalis, candidemia, hematological malignancy, neutropenia, amphotericin B, echinocandins

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