Document Detail


Effect of antifungal therapy timing on mortality in cancer patients with candidemia.
MedLine Citation:
PMID:  19884371     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Prior studies have shown that delays in treatment are associated with increased mortality in patients with candidemia. The purpose of this study was to measure three separate time periods comprising the diagnosis and treatment of candidemia and to determine which one(s) is associated with hospital mortality. Patients with blood cultures positive for Candida spp. were identified. Subjects were excluded if no antifungal therapy was given or if there was preexisting antifungal therapy. Collected data included the time from blood culture collection to positivity (incubation period), the time from blood culture positivity to provider notification (provider notification period), and the time from provider notification to the first dose of antifungal given (antifungal initiation period). These times were assessed as predictors of inpatient mortality. A repeat analysis was done with adjustments for age, sex, race, underlying cancer, catheter removal, APACHE III score, acute renal failure, neutropenia, and non-Candida albicans species. A total of 106 episodes of candidemia were analyzed. The median incubation time was 32.1 h and was associated with mortality (univariate hazard ratio per hour, 1.025; P = 0.001). The median provider notification and antifungal initiation periods were 0.3 and 7.5 h, respectively, and were not associated with mortality. Adjusted analysis yielded similar results. For cancer patients with candidemia, the incubation period accounts for a significant amount of time, compared with the provider notification and antifungal initiation times, and is associated with in-hospital mortality. Strategies to shorten the incubation time, such as utilizing rapid molecularly based diagnostic methods, may help reduce in-hospital mortality.
Authors:
Ying Taur; Nina Cohen; Sarah Dubnow; Alla Paskovaty; Susan K Seo
Publication Detail:
Type:  Journal Article     Date:  2009-11-02
Journal Detail:
Title:  Antimicrobial agents and chemotherapy     Volume:  54     ISSN:  1098-6596     ISO Abbreviation:  Antimicrob. Agents Chemother.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-21     Completed Date:  2010-03-15     Revised Date:  2010-09-27    
Medline Journal Info:
Nlm Unique ID:  0315061     Medline TA:  Antimicrob Agents Chemother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  184-90     Citation Subset:  IM    
Affiliation:
Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 9, New York, NY 10065, USA. taury@mskcc.org
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adolescent
Adult
Aged
Aged, 80 and over
Antifungal Agents / administration & dosage*,  therapeutic use*
Blood / microbiology
Candidiasis / complications*,  drug therapy,  mortality*
Child
Child, Preschool
Cohort Studies
Female
Hospital Mortality
Humans
Infant
Kidney Failure, Acute / complications,  mortality
Male
Middle Aged
Multivariate Analysis
Neoplasms / complications*,  mortality*
Retrospective Studies
Young Adult
Chemical
Reg. No./Substance:
0/Antifungal Agents
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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