TY - JOUR
T1 - Clinical evaluation of antifungal de-escalation in Candida infections
T2 - A systematic review and meta-analysis
AU - Albanell-Fernández, Marta
AU - Salazar González, Fernando
AU - Montero Pérez, Olalla
AU - Aniyar, Victoria
AU - Carrera Hueso, Francisco Javier
AU - Soriano, Alex
AU - García-Vidal, Carolina
AU - Puerta-Alcalde, Pedro
AU - Martínez, José Antonio
AU - Vázquez Ferreiro, Pedro
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/6
Y1 - 2024/6
N2 - 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.
AB - 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.
KW - 30-day survival
KW - Azoles
KW - Candida
KW - De-escalation
KW - Echinocandins
KW - Meta-analysis
UR - https://www.scopus.com/pages/publications/85190595234
U2 - 10.1016/j.ijid.2024.107020
DO - 10.1016/j.ijid.2024.107020
M3 - Article
C2 - 38548167
AN - SCOPUS:85190595234
SN - 1201-9712
VL - 143
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
M1 - 107020
ER -