Photo Credit: Dr Microbe
The following is a summary of “Clinical evaluation of antifungal de-escalation in Candida infections: A systematic review and meta-analysis,” published in the April 2024 issue of Infectious Disease by Albanell-Fernández et al.
Medical societies recommend de-escalation therapy (DES), switching from echinocandins to azoles, for Candida infections.
Researchers conducted a retrospective study investigating the effectiveness of DES compared to continuing echinocandins (non-DES) in treating Candida infections, focusing on clinical and microbiological cure rates and 30-day survival.
They searched MEDLINE, Embase, Web of Science, and Scopus. Included were studies on inpatients describing DES and reporting any evaluated outcomes. Pooled estimates of the three outcomes were calculated using fixed or random-effects models. Heterogeneity was investigated by subgroup analysis and meta-regression.
The results showed 1,853 records and 9 studies were chosen involving 1,575 patients. About 5 studies switched to fluconazole, one to voriconazole, and three to any azoles. The average duration of DES was 5.2 days (range: 4.6-6.5). The OR for clinical cure was 1.29 (95% CI: 0.88-1.88); for microbiological cure, it was 1.62 (95% CI: 0.71-3.71); and for 30-day survival, it was 2.17 (95% CI: 1.09-4.32). Subgroup analysis of 30-day survival data indicated a more potent effect among patients who were critically ill and studies with a severe risk of bias. Meta-regression found no significant effect modifiers.
Investigators concluded that de-escalation (DES) was a safe approach, with no increase in 30-day mortality and a potential benefit for achieving clinical and microbiological cures.
Source: sciencedirect.com/science/article/pii/S1201971224000912