Abstract | BACKGROUND: METHODS: Global responses at end of intravenous study treatment in patients with C. albicans infection were compared post-hoc. Multivariate logistic regression analyses were performed to predict response and to adjust for differences in independent baseline characteristics. Analyses focused on time to negative blood cultures, persistent infection at end of intravenous study treatment, and 6-week survival. RESULTS: In total, 135 patients with C. albicans infections were identified. Among these, baseline APACHE II scores were similar between treatment arms. In these patients, global response was significantly better for anidulafungin than fluconazole (81.1% vs 62.3%; 95% confidence interval [CI] for difference, 3.7-33.9). After adjusting for baseline characteristics, the odds ratio for global response was 2.36 (95% CI, 1.06-5.25). Study treatment and APACHE II score were significant predictors of outcome. The most predictive logistic regression model found that the odds ratio for study treatment was 2.60 (95% CI, 1.14-5.91) in favor of anidulafungin, and the odds ratio for APACHE II score was 0.935 (95% CI, 0.885-0.987), with poorer responses associated with higher baseline APACHE II scores. Anidulafungin was associated with significantly faster clearance of blood cultures (log-rank p < 0.05) and significantly fewer persistent infections (2.7% vs 13.1%; p < 0.05). Survival through 6 weeks did not differ between treatment groups. CONCLUSIONS: In patients with C. albicans infection, anidulafungin was more effective than fluconazole, with more rapid clearance of positive blood cultures. This suggests that the fungicidal activity of echinocandins may have important clinical implications. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00058682.
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Authors | Annette C Reboli, Andrew F Shorr, Coleman Rotstein, Peter G Pappas, Daniel H Kett, Haran T Schlamm, Arlene L Reisman, Pinaki Biswas, Thomas J Walsh |
Journal | BMC infectious diseases
(BMC Infect Dis)
Vol. 11
Pg. 261
(Sep 30 2011)
ISSN: 1471-2334 [Electronic] England |
PMID | 21961941
(Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © 2011 Reboli et al; licensee BioMed Central Ltd. |
Chemical References |
- Antifungal Agents
- Echinocandins
- Fluconazole
- Anidulafungin
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Topics |
- Anidulafungin
- Antifungal Agents
(administration & dosage)
- Candida albicans
(drug effects, isolation & purification)
- Candidiasis, Invasive
(drug therapy, microbiology, mortality, pathology)
- Echinocandins
(administration & dosage)
- Fluconazole
(administration & dosage)
- Humans
- Multivariate Analysis
- Survival Analysis
- Treatment Outcome
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