CURRENT TREATMENT OF CANDIDEMIA IN NON-NE UTROPENIC PATIENTS - AMPHOTERICIN-B OR FLUCONAZOLE - RETROSPECTIVE STUDY OF 62 CONSECUTIVE CASES

Background. To analyze the epidemiologic characteristics of non-neutro penic patients with candidemia in a general hospital and the advantage s and disadvantages of treatment with amphotericin B or fluconazole. P atients and methods. A total of 62 adult non-neutropenic patients with candidemia and treated with amphotericin B (n = 35) or fluconazole (n = 27) were studied. All episodes were considered to be associated wit h infection in a vein catheter. The demographic characteristics, risk factors for the development of candidemia, Candida species recovered f rom blood culture, underlying diseases, and clinical manifestations in both groups were compared. The evolution regarding secondary effects developed with both drugs, therapy failures, long term complications, and overall mortality rate associated with candidemia were analyzed. R esults. Both groups were comparable with the exception of the percenta ge of patients infected with species different from Candida albicans, which was higher in the group of patients who received amphotericin B (57%) than in the fluconazole group (26%) (p = 0.02), and in that pati ents with severe renal failure or AIDS had received preferentially flu conazole. There were no statistically significant differences regardin g the evolution of patients treated with amphotericin B or fluconazole with the following factors: therapy failure (27% versus 19%; p = 0.7) , overall mortality rate (40% versus 44%; p = 0.6), and mortality dire ctly related to candidemia (33% versus 30%). Mortality was significant ly higher among patients who had not their vein catheters removed earl y (78%) compared with those who had their vein catheters removed early (34%) (p = 0.01). Sixty-six percent of patients treated with amphoter icin developed some severe secondary effect, whereas no patient in the fluconazole group developed such effects. Conclusions. Both amphoteri cin B and fluconazole seem to be effective drugs for the treatment of vein catheter related candidemia in the non-neutropenic patient, altho ugh fluconazole is far less toxic. The early removal of the vein cathe ter plays a prognostic role with at least the same relevance than the type of antifungal therapy chosen.