Clinical evaluation of antifungal de-escalation in Candida infections : A systematic review and meta-analysis
Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved..
OBJECTIVES: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30-day survival and compare it with continuing the treatment with echinocandins (non-DES).
METHODS: We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random-effects model. Heterogeneity was explored stratifying by subgroups and via meta-regression. This systematic review is registered with PROSPERO (CRD42023475486).
RESULTS: Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies stepped-down to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30-day survival 2.17 (95% CI: 1.09-4.32). The 30-day survival data into subgroups showed higher effect on critically ill patients and serious-risk bias studies. Meta-regression did not identify significant effect modifiers.
CONCLUSIONS: DES is a safe strategy; it showed no higher 30-day mortality and a trend towards greater clinical and microbiological cure.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:143 |
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| Enthalten in: |
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases - 143(2024) vom: 26. März, Seite 107020 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Albanell-Fernández, Marta [VerfasserIn] |
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| Links: |
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| Themen: |
30-day survival |
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| Anmerkungen: |
Date Revised 18.04.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1016/j.ijid.2024.107020 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM37037701X |
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| 520 | |a Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a OBJECTIVES: De-escalation (DES) from echinocandins to azoles is recommended by several medical societies in Candida infections. We summarise the evidence of DES on clinical and microbiological cure and 30-day survival and compare it with continuing the treatment with echinocandins (non-DES) | ||
| 520 | |a METHODS: We searched MEDLINE, Embase, Web of Science and Scopus. Studies describing DES in inpatients and reporting any of the outcomes evaluated were included. Pooled estimates of the tree outcomes were calculated with a fixed or random-effects model. Heterogeneity was explored stratifying by subgroups and via meta-regression. This systematic review is registered with PROSPERO (CRD42023475486) | ||
| 520 | |a RESULTS: Of 1853 records identified, 9 studies were included, totalling 1575 patients. Five studies stepped-down to fluconazole; one to voriconazole and three to any of azoles. The mean day of DES was 5.2 (4.6-6.5) days. The clinical cure OR was 1.29 (95% CI: 0.88-1.88); the microbiological cure 1.62 (95% CI: 0.71-3.71); and 30-day survival 2.17 (95% CI: 1.09-4.32). The 30-day survival data into subgroups showed higher effect on critically ill patients and serious-risk bias studies. Meta-regression did not identify significant effect modifiers | ||
| 520 | |a CONCLUSIONS: DES is a safe strategy; it showed no higher 30-day mortality and a trend towards greater clinical and microbiological cure | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 30-day survival | |
| 650 | 4 | |a Azoles | |
| 650 | 4 | |a Candida | |
| 650 | 4 | |a De-escalation | |
| 650 | 4 | |a Echinocandins | |
| 650 | 4 | |a Meta-analysis | |
| 700 | 1 | |a Salazar González, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Montero Pérez, Olalla |e verfasserin |4 aut | |
| 700 | 1 | |a Aniyar, Victoria |e verfasserin |4 aut | |
| 700 | 1 | |a Carrera Hueso, Francisco-Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Soriano, Alex |e verfasserin |4 aut | |
| 700 | 1 | |a García-Vidal, Carolina |e verfasserin |4 aut | |
| 700 | 1 | |a Puerta-Alcalde, Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Martínez, José Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Vázquez Ferreiro, Pedro |e verfasserin |4 aut | |
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