Short Course of Antifungal Therapy in Patients with Uncomplicated Candida Bloodstream Infection: Another Case of Less is More in the Clinical Setting?


 
 
 To compare the clinical outcomes of patients receiving short course (SC) or prolonged course (PC) of antifungal therapy for uncomplicated Candida bloodstream infections (BSI).
 
 
 
 All episodes of uncomplicated Candida BSI from 1 September 2018 to 31 August 2020 were reviewed. We compared the primary (all cause 90-day mortality) and secondary study endpoints (1-year recurrent Candida BSI and all-cause 1-year-mortality) among patients who underwent SC (5-11 days) or PC (12-24 days) therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method.
 
 
 
 A total of 114 patients with uncomplicated Candida BSI were included: 35 (30.7%) were classified into the SC-group [median of 9 days (IQR 7-11 days)] and 79 (69.3%) into the PC-group [median of 14 days (IQR 14-16 days)]. Patients in SC-group compared to PC-group had a higher rate of hospitalization in the surgical ward (40.0% vs 19.0%, p = 0.02), or septic shock at the time of Candida BSI onset (11.4% vs 1.3%; p = 0.03). The risk of 90 day-mortality was not different between SC and PC groups [n = 8 (22.9%) vs 17 (21.5%), respectively; IPTW-adjusted sHR = 0.67; 95% CI = 0.31-1.47, P = 0.20]. The risk for recurrent Candida BSI within 1 year of completing therapy (IPTW-adjusted sHR = 1.07; 95% CI = 0.20-5.80, p = 0.94) or for all cause 1-year mortality (IPTW-adjusted HR = 0.72; 95% CI = 0.35-1.50, p = 0.38) did not differ between groups.
 
 
 
 Short or prolonged course of antifungal therapy do not affect mortality and BSI recurrence in patients with uncomplicated candidemia.
