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Transcripción de la presentación:

Impact of fluconazole susceptibility on the outcome of patients with candidaemia: data from a population-based surveillance M. Fernández-Ruiz, J. Guinea, D. Lora-Pablos, Ó. Zaragoza, M. Puig-Asensio, B. Almirante, M. Cuenca-Estrella, J.M. Aguado B. Padilla, P. Muñoz, J. Guinea, J.R. Paño Pardo, J. García-Rodríguez, C.G. Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos Gil, V. Buendía, B.P. Gorricho, M. Alonso, F.S. Sanz, J.M. Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J.E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I.S. Romero, O. Zaragoza, M. Cuenca-Estrella, J. Rodríguez-Baño, A.I. Suarez, A. Loza, A.I. Aller García, E. Martín-Mazuelos, M.R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F.L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J.J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernández, G. Ezpeleta, E. Bereciartua, J.L. Hernández Almaraz, M. Montejo, R.A. Rivas, R. Ayarza, A.M. Planes, I.R. Camps, B. Almirante, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martínez-Montauti, M. Sierra, J.P. Horcajada, L. Sorli, J. Gómez, A. Gené, M. Urrea, A. Mularoni, M. Valerio, A. Díaz- Martín, F. Puchades M. Fernández-Ruiz, J. Guinea, D. Lora-Pablos, Ó. Zaragoza, M. Puig-Asensio, B. Almirante, M. Cuenca-Estrella, J.M. Aguado B. Padilla, P. Muñoz, J. Guinea, J.R. Paño Pardo, J. García-Rodríguez, C.G. Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos Gil, V. Buendía, B.P. Gorricho, M. Alonso, F.S. Sanz, J.M. Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J.E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I.S. Romero, O. Zaragoza, M. Cuenca-Estrella, J. Rodríguez- Baño, A.I. Suarez, A. Loza, A.I. Aller García, E. Martín-Mazuelos, M.R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F.L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J.J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernández, G. Ezpeleta, E. Bereciartua, J.L. Hernández Almaraz, M. Montejo, R.A. Rivas, R. Ayarza, A.M. Planes, I.R. Camps, B. Almirante, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martínez-Montauti, M. Sierra, J.P. Horcajada, L. Sorli, J. Gómez, A. Gené, M. Urrea, A. Mularoni, M. Valerio, A. Díaz-Martín, F. Puchades Clinical Microbiology and Infection Volume 23, Issue 9, Pages 672.e1-672.e11 (September 2017) DOI: 10.1016/j.cmi.2017.01.014 Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 1 Relationship between primary (clinical failure) and secondary study outcomes (early and late mortality) and fluconazole MIC values assessed according to (a) EUCAST and (b) CLSI procedures. CLSI, Clinical and Laboratory Standards Institute; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MIC, minimum inhibitory concentration. Clinical Microbiology and Infection 2017 23, 672.e1-672.e11DOI: (10.1016/j.cmi.2017.01.014) Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 2 ORs (circles) with 95% CIs (whiskers) for clinical failure according to selected cutoff values of fluconazole MIC and different methodologies for antifungal susceptibility testing. (a) Unadjusted. (b) Adjusted for age, receipt of RRT and parenteral nutrition at diagnosis, Pitt score and early CVC removal (≤48 hours). CI, confidence interval; CLSI, Clinical and Laboratory Standards Institute; CVC, central venous catheter; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MIC, minimum inhibitory concentration; OR odds ratio; RRT, renal replacement therapy. Clinical Microbiology and Infection 2017 23, 672.e1-672.e11DOI: (10.1016/j.cmi.2017.01.014) Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 3 Relationship between primary (clinical failure) and secondary study outcomes (early and late mortality) and fluconazole exposure. AUC24, 24-hour area under concentration–time curve. Clinical Microbiology and Infection 2017 23, 672.e1-672.e11DOI: (10.1016/j.cmi.2017.01.014) Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 4 Relationship between primary (clinical failure) and secondary study outcomes (early and late mortality) and fluconazole AUC24/MIC ratio (stratified by quintiles), with MIC values assessed according to (a) EUCAST and (b) CLSI procedures. AUC24, 24-hour area under concentration–time curve; CLSI, Clinical and Laboratory Standards Institute; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MIC, minimum inhibitory concentration. Clinical Microbiology and Infection 2017 23, 672.e1-672.e11DOI: (10.1016/j.cmi.2017.01.014) Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions

Fig. 5 ORs (circles) with 95% CIs (whiskers) for clinical failure according to selected cutoff values of fluconazole AUC24/MIC ratio. (a) Unadjusted. (b) Adjusted for age, receipt of RRT and parenteral nutrition at diagnosis, Pitt score and early CVC removal (≤48 hours). AUC24, 24-hour area under concentration–time curve; CI, confidence interval; CLSI, Clinical and Laboratory Standards Institute; CVC, central venous catheter; EUCAST, European Committee on Antimicrobial Susceptibility Testing; MIC, minimum inhibitory concentration; OR odds ratio; RRT, renal replacement therapy. Clinical Microbiology and Infection 2017 23, 672.e1-672.e11DOI: (10.1016/j.cmi.2017.01.014) Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases Terms and Conditions