Utility of in-house fluconazole disk diffusion susceptibility testing in the treatment of candidemia

David W Kubiak; Dimitrios Farmakiotis; Viktoria Arons; Randy M Hollins; Sara E Rostas; Linda M Weiser; Lindsey R Baden; Francisco M Marty; Sophia Koo

doi:10.1016/j.diagmicrobio.2015.11.018

Utility of in-house fluconazole disk diffusion susceptibility testing in the treatment of candidemia

Diagn Microbiol Infect Dis. 2016 Mar;84(3):223-6. doi: 10.1016/j.diagmicrobio.2015.11.018. Epub 2015 Nov 24.

Authors

David W Kubiak¹, Dimitrios Farmakiotis², Viktoria Arons³, Randy M Hollins³, Sara E Rostas³, Linda M Weiser⁴, Lindsey R Baden⁵, Francisco M Marty⁵, Sophia Koo⁶

Affiliations

¹ Department of Pharmacy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address: [email protected].
² Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02115, USA.
³ Department of Pharmacy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
⁴ Clinical Microbiology Laboratory, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
⁵ Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Infectious Diseases, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02115, USA.
⁶ Division of Infectious Diseases, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Division of Infectious Diseases, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA 02115, USA. Electronic address: [email protected].

Abstract

Among 302 first candidemia episodes, 210 (69.6%) were initially treated with an echinocandin or polyene (E/P) antifungal drug. In 137 (72.5%) patients with fluconazole-susceptible isolates, treatment was changed to fluconazole based on disk diffusion susceptibility testing. Clinical outcomes were not compromised in patients receiving E/P who were de-escalated to fluconazole for treatment of candidemia based on disk diffusion results.

Keywords: Candidemia; Disk diffusion susceptibility testing; Fluconazole.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Antifungal Agents / pharmacology*
Antifungal Agents / therapeutic use*
Candidemia / diagnosis*
Candidemia / drug therapy*
Candidemia / etiology
Candidemia / mortality
Cohort Studies
Disk Diffusion Antimicrobial Tests*
Female
Fluconazole / pharmacology*
Fluconazole / therapeutic use*
Humans
Male
Middle Aged
Recurrence
Risk Factors
Treatment Outcome
Young Adult

Substances

Antifungal Agents
Fluconazole

Grants and funding

K23 AI097225/AI/NIAID NIH HHS/United States