You have full access to this open access article. To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp.
The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous iv antifungal treatment AF Tx. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx. In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx aOR 2.
Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. Invasive candidiasis IC including candidemia remains the most frequent invasive fungal infection in European and worldwide hospitals [ 1 , 2 ]. Early adequate antifungal treatment is efficacious and one of the most important predictors of survival [ 5 ]. While stepdown to oral fluconazole treatment can be considered after 5 days or even earlier [ 8 , 9 ], fluconazole has a narrower spectrum of activity paired with the continuous emergence of azole resistance among non-albicans Candida spp.
Therefore, stepdown to an oral agent is not always feasible and prolonged intravenous iv antifungal treatment AF Tx may be necessary.
This may prevent otherwise timely discharge of patients, meaning prolonged hospitalization to complete iv AF Tx or daily outpatient iv treatment, if available. Results are increased costs, risk for nosocomial infections, and avoidable waste of resources. New antifungals, including rezafungin echinocandin with prolonged half-life allowing once-a-week administration and ibrexafungerp oral triterpenoid glucan synthase inhibitor are currently in late stage clinical development and may help tackle this problem [ 12 , 13 ].
