Delay From Hypotension Onset to Appropriate Antifungal Therapy Initiation Is the Critical Determinant of Outcome in Candida Septic Shock
Authors' conclusion
Administration of PAAs within the first hours of documented hypotension significantly improved hospital survival. Less than 20% of patients received appropriate antifungals within 6 hours of documented hypotension.
Study context
- Population
- Adult patients with culture-positive Candida septic shock in academic and community hospitals in Canada, the United States, and Saudi Arabia (July 1989 to June 2018)32 academic and community hospitals
- Participants
- 850 patients
- Exposure
- Delay from onset of persistent hypotension to initiation of appropriate antifungal therapy, per hour of delay
- Outcome
- Appropriate antifungal therapy after onset of persistent hypotension
Main finding
As reported in the abstract
Received appropriate antifungal therapy after the onset of persistent hypotension
69.2%
589
Observational data: associations, not effects.
Further findings
| Outcome | Adjusted OR of death (per hour of delay) (95% CI) | P value | |
|---|---|---|---|
| Hospital deathAdjusted | 1.045 (1.035–1.056) | P < 0.0001 | |
| 0.512Adjusted OR of death (log scale) |
Hospital survival by time to appropriate antifungal
- Survival rate when appropriate antifungal administered within 2 hours of initial documentation of persistent hypotension
- 86%
- Average decrease in hospital survival per hour of delay thereafter, to 10-12 hours of delay
- 5.0%
Predictors of outcome (multivariate analysis including APACHE II score and epidemiologic/therapeutic variables)
- Time to initiation of appropriate antifungal therapy emerged as the single strongest predictor of outcome
Sensitivity analysis across subgroups (types of infections, pathogens, antifungal drug classes)
- Adverse effects of delayed antifungal treatment consistent across subgroups
Time to appropriate antifungal therapy
- Median time to appropriate antifungal therapy
- 32.3 hours (interquartile range, 11.2-66.0 hr)
- Receiving therapy within 6 hours of hypotension onset
- 16.9%
Original publication
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