Directed antifungal treatment In patients with candidemia: Factors that influence drug selection

Introduction: Invasive candidiasis is a severe infection that frequently affects hospitalized patients. It can be caused by different strains of Candida spp, some of them are resistant to fluconazole and can be treated with echinocandins. Echinocandins are very useful for invasive candidiasis treatment; however, they are not very efficient due to their high cost. The main objective of this study is to identify the variables determining the prescription of antifungal other than fluconazole when treating invasive candidiasis. Method: Observational, retrospective unicentric study including patients diagnosed with invasive candidiasis during the years 2010 to 2014. Information about Candida spp. strain, antifungal sensitivity and antifungals prescribed was recorded. Results: Out of 127 invasive candidiasis cases recorded, 52% were caused by C. albicans. 100% of C. albicans and C. parapsilosis strains and 87% of C. gla-brata strains studied were sensitive to fluconazole. Fluconazole was the most commonly prescribed antifungal (72%), followed by echinocandins. Factors determining the prescription of an antifungal other than fluconazole were: positive blood culture of a strain not sensitive to fluconazole, recent fluconazole prophylactic treatment and identification of C. glabrata and C. krusei (p <0.05). Discussion: The distribution of Candida spp species identified in this study is different from others reported in different times and locations. Fluconazole was the most prescribed drug for invasive candidiasis, which is the best choice in clinical, economical and epidemiological terms. Identification of variables affecting the antifungal treatment choice promotes a better communication with the medical team and promotes the best treatment choice