AAC Accepts, published online ahead of print on 2 November 2009

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Antimicrob. Agents Chemother. doi:10.1128/AAC.00945-09
Copyright (c) 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

The Effect of Antifungal Timing on Mortality in Cancer Patients with Candidemia

Ying Taur^*, Nina Cohen, Sarah Dubnow, Alla Paskovaty, and Susan K. Seo

Memorial Sloan-Kettering Cancer Center, 1275 York Avenue Box 9, New York, NY

^* To whom correspondence should be addressed. Email: taury{at}mskcc.org.

Prior studies have shown that delays in treatment are associated with increased mortality in patients with candidemia. The purpose of this study was to measure three separate time periods comprising the diagnosis and treatment of candidemia and to determine which one(s) are associated with hospital mortality. Patients with a positive blood culture for Candida were identified. Subjects were excluded if no antifungal therapy was given or if there was preexisting antifungal therapy. Collected data included: time from blood culture collection to positivity (incubation period), time from blood culture positivity to provider notification (provider notification period), and time from provider notification to the first dose of antifungal given (antifungal initiation period). These times were assessed as predictors of inpatient mortality. A repeat analysis was done with adjustments for age, sex, race, underlying cancer, catheter removal, APACHE III score, acute renal failure, neutropenia, and non-albicans species. There were 106 episodes of candidemia that were analyzed. The median incubation time period was 32.1 hours and was associated with mortality (univariate hazard ratio per hour: 1.025, P=0.001). The median provider notification and antifungal initiation time periods were 0.3 and 7.5 hours, respectively and were not associated with mortality. Adjusted analysis yielded similar results. In cancer patients with candidemia, the incubation period accounts for a significant amount of time, compared with provider notification and antifungal initiation times and is associated with in-hospital mortality. Strategies to shorten the incubation time, such as utilizing rapid molecular-based diagnostic methods, may help reduce in-hospital mortality.