Echinocandins Versus Azoles for Candidemia Treatment

Study Overview
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Brief Summary
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Candidemia is the most frequent invasive fungal disease in intensive care units (ICUs). It remains a major health concern, considering its attributable mortality up to 40% in critically ill patients. Successful clinical outcome requires early diagnosis and effective antifungal therapy. Guidelines for the treatment of candidemia were published by the Infectious Diseases Society of America (IDSA) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). According to these guidelines, echinocandins are the preferred first-line therapy for candidemia in critically ill patients. Considering the bibliography supporting this statement, the place of triazoles still needs to be defined in candidemia therapeutic arsenal. In this context, we are setting up a retrospective cohort study using Hospital database to compare the efficacy of echinocandins and azoles for the treatment of candidemia in intensive care units.

Official Title
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Echinocandins Versus Azoles as First-line Therapy for the Treatment of Candidemia in Intensive Care Units

Conditions
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Candidemia

Intervention / Treatment
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* Drug: Echinocandin treatment
* Drug: Triazole treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who had a diagnosis of candidemia during ICU stay and were treated with echinocandins or azoles Exclusion Criteria: Patients with neutropenia Patients without antifungal treatment Patients who received antifungal therapy for more than two days before candidemia diagnosis Patients receiving liposomal amphotericin b or multiple antifungal agents as first-line therapy Patients who received less than 4 days of antifungal therapy after candidemia diagnosis
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Echinocandin group<br>Echinocandin group is the group of patients who received echinocandins as first-line therapy for candidemia | Drug: Echinocandin treatment<br>* Patients received echinocandins as a first-line therapy after candidemia diagnosis according to the standard of care<br>|
| Triazole group<br>Triazole group is the group of patients who received triazoles as first-line therapy for candidemia | Drug: Triazole treatment<br>* Patients received triazoles as a first-line therapy after candidemia diagnosis according to the standard of care. Candidemia was defined as at least one blood culture positive for Candida.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of all cause hospital mortality on day 90 between echinocandins and azoles | Comparison of all cause hospital mortality on day 90 between echinocandins and azoles | Mortality on day 90 after antifungal initiation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Comparison of treatment success on day 30 between echinocandins and azoles. | Treatment success is defined as a complete response if the following two criteria were full-filled: survival and resolution of all attributable symptoms and signs of disease, and mycological success (documented clearance of pathogen from the blood). | Treatment success on day 30 after antifungal initiation |