Abstract
Candida osteomyelitis is associated with significant morbidity; however, data on the management of Candida osteomyelitis are limited. The Prospective Antifungal Therapy (PATH) Alliance® registry is a comprehensive, multicenter, prospective, observational registry that collected data on patients with invasive fungal infections between 2004 and 2008. The aim of this descriptive analysis was to evaluate the clinical characteristics, treatment, and outcomes of patients with Candida osteomyelitis. Using the PATH Alliance® registry, we performed a review of all patients with a proven diagnosis of Candida osteomyelitis who received a minimum of 14 days of antifungal treatment and/or a therapeutic surgical intervention (n = 53). The epidemiology, diagnosis, treatment, and outcomes of these patients were assessed at 12 weeks. C. albicans (56.6 %) was the most commonly identified organism, followed by C. parapsilosis (18.9 %), C. glabrata (9.4 %), and C. tropicalis (9.4 %). The mean treatment duration was 54.9 days. Multiple different treatment regimens were administered to patients. These included fluconazole (56.0 %), echinocandins (29.3 %), amphotericin B formulations (10.7 %), and voriconazole (4.0 %). Twenty-eight patients (52.8 %) also had a therapeutic surgical intervention. Clinical response was improved in 38 (71.7 %) patients (43.4 % complete and 28.3 % partial response), stable in 11 (20.8 %), and worse in one (1.9 %); three (5.7 %) patients had unknown response. The 12-week survival rate was 93.8 %. In summary, C. albicans was the predominant pathogen, and fluconazole was the most commonly administered agent. However, treatment patterns vary and remain non-standardized. Concurrent candidemia was infrequent, and 12-week survival was notably good in this series of 53 patients with Candida osteomyelitis.
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Acknowledgments
We would like to thank Elizabeth Crane, Shun-Ping Quan, and Alan Fan for their significant technical support, and Neil M. Thomas of Envision Pharma for his editorial assistance, funded by Astellas.
Conflict of interest
D.N. has received research grants from Pfizer, and served on advisory boards and acted as a consultant for Roche and Astellas.
S.H. has served on advisory boards for Merck and Gilead.
A.R. has received research grant support from Merck and Pfizer, been on advisory boards for Merck, Pfizer, and Astellas, and given lectures supported by Merck and Pfizer.
D.H. is a consultant to Astellas.
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Neofytos, D., Huprikar, S., Reboli, A. et al. Treatment and outcomes of Candida osteomyelitis: review of 53 cases from the PATH Alliance® registry. Eur J Clin Microbiol Infect Dis 33, 135–141 (2014). https://doi.org/10.1007/s10096-013-1939-0
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DOI: https://doi.org/10.1007/s10096-013-1939-0