Factors related to survival and treatment success in invasive candidiasis or candidemia: a pooled analysis of two large, prospective, micafungin trials

  • D. L. Horn
  • L. Ostrosky-Zeichner
  • M. I. Morris
  • A. J. Ullmann
  • C. Wu
  • D. N. Buell
  • L. L. Kovanda
  • O. A. Cornely
Article

DOI: 10.1007/s10096-009-0843-0

Cite this article as:
Horn, D.L., Ostrosky-Zeichner, L., Morris, M.I. et al. Eur J Clin Microbiol Infect Dis (2010) 29: 223. doi:10.1007/s10096-009-0843-0

Abstract

Crude and attributable mortality rates in patients with candidemia and invasive candidiasis remain unacceptably high. It is important to reach a more complete understanding of the risk factors underlying poor outcomes in patients with invasive Candida infections. Micafungin therapy has been assessed in two phase 3 trials compared to either liposomal amphotericin B or caspofungin. The availability of this large dataset allows the analyses of non-drug factors associated with survival and treatment success. A multivariate regression analysis was performed on data from the two trials separately and as a pooled analysis (N = 1,070). Analysis outcomes were survival at 42 days post-initiation of therapy and treatment success. For the pooled analysis, treatment success was significantly more likely for candidemia than invasive candidiasis. Both survival and treatment success were significantly less likely for the non-removal of catheter versus removal, Asian-Indians versus Caucasians, APACHE II score >20 to ≤30 and >30 versus ≤20, age ≥70 years versus <50 years, baseline corticosteroids, and persistent neutropenia. Survival was also significantly less likely for treatment in other regions versus North America and for patients with renal failure at baseline. These findings help to define non-antifungal drug factors that may impact survival and treatment success in invasive candidiasis or candidemia.

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • D. L. Horn
    • 1
  • L. Ostrosky-Zeichner
    • 2
  • M. I. Morris
    • 3
  • A. J. Ullmann
    • 4
  • C. Wu
    • 5
  • D. N. Buell
    • 5
  • L. L. Kovanda
    • 5
  • O. A. Cornely
    • 6
  1. 1.Clinical Research, Division of Infectious DiseasesThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.University of Texas Medical School at HoustonHoustonUSA
  3. 3.University of Miami Miller School of MedicineMiamiUSA
  4. 4.III. Medizinische Klinik und PoliklinikKlinikum der Johannes Gutenberg-UniversitätMainzGermany
  5. 5.Astellas Pharma Global Development Inc.DeerfieldUSA
  6. 6.Klinik I für Innere Medizin, Zentrum für Klinische Studien (ZKS Köln; BMBF 01KN0706)Universität zu KölnKölnGermany