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Candidaemia mortality is reduced by echinocandins only in the absence of septic shock

September 02 2019

In 5 major hospitals in Italy, Marco Falcone and colleagues analysed the survival patients with and with septic shock on medical wards. A remarkable 172 of 439 (39.2%) with candidaemia presented with septic shock. The overall 30 day mortality was higher in this with septic shock (45.3%) compared to those without septic shock (31.5%) (p=0.003). Initial echinocandin use (first 48 hours) did not improve survival in those with septic shock, but had major benefit in those without septic shock compared to either fluconazole or voriconazole (HR 0.43, p= 0.02).

Initial therapy

Overall 30 day survival

Septic shock

No septic shock

Azole

48.9%

32.2%

Echinocandin

53.8%

14.3%

There was no apparent impact according to Candida species - C. albicans accounted for 52.7% of cases and Candida glabrata (6.8%) and Candida krusei (2%), under 10% of cases.

Current European and US guidelines recommend echinocandin therapy of the most ill, unstable patients with candidaemia. These data point towards the opposite- that echincandins should be used initially in everyone with candidaemia, although the mortality is higher in those with septic shock.