Echinocandins Compared to Fluconazole for Candidemia of a Urinary Tract Source: A Propensity Score Analysis

Clin Infect Dis. 2017 May 15;64(10):1374-1379. doi: 10.1093/cid/cix033.


Background: Whether echinocandins could be used to treat candidemia of a urinary tract source (CUTS) is unknown. We aimed to provide current epidemiological information of CUTS and to compare echinocandin to fluconazole treatment on CUTS outcomes.

Methods: A multicenter study of adult patients with candidemia was conducted in 9 hospitals. CUTS was defined as a candidemia with concomitant candiduria by the same organism associated with significant urological comorbidity. The primary outcome assessed was clinical failure (defined by 7-day mortality or persistent candidemia) in patients treated with either an echinocandin or fluconazole. A propensity score was calculated and then entered into a regression model.

Results: Of 2176 episodes of candidemia, 128 were CUTS (5.88%). Most CUTS cases were caused by Candida albicans (52.7%), followed by Candida glabrata (25.6%) and Candida tropicalis (16.3%). Clinical failure occurred in 7 patients (20%) treated with an echinocandin and in 15 (17.1%) treated with fluconazole (P = .730). Acute renal failure (adjusted odds ratio [AOR], 3.01; 95% confidence interval [CI], 1.01-8.91; P = .047) was the only independent factor associated with clinical failure, whereas early urinary tract drainage procedures (surgical, percutaneous, or endoscopic) were identified as protective (AOR, 0.08; 95% CI, .02-.31; P < .001). Neither univariate nor multivariate analysis showed that echinocandin therapy altered the risk of clinical failure.

Conclusions: Initial echinocandin therapy was not associated with clinical failure in patients with CUTS. Notably, acute renal failure predicted worse outcomes and performing an early urologic procedure was a protective measure.

Keywords: candidemia; echinocandin therapy; propensity score.; urinary source.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Candida albicans / drug effects
  • Candida albicans / isolation & purification
  • Candida glabrata / drug effects
  • Candida glabrata / isolation & purification
  • Candidemia / drug therapy*
  • Candidemia / microbiology
  • Candidemia / mortality
  • Cohort Studies
  • Comorbidity
  • Echinocandins / administration & dosage
  • Echinocandins / therapeutic use*
  • Female
  • Fluconazole / administration & dosage
  • Fluconazole / therapeutic use*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Multivariate Analysis
  • Propensity Score
  • Renal Insufficiency / microbiology
  • Treatment Outcome
  • Urinary Tract Infections / drug therapy*
  • Urinary Tract Infections / microbiology


  • Antifungal Agents
  • Echinocandins
  • Fluconazole