{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:16:56Z","timestamp":1787008616083,"version":"build-2736575974"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"9","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["CDC-RFA-CK17-1701"],"award-info":[{"award-number":["CDC-RFA-CK17-1701"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Candidemia is a common opportunistic infection causing substantial morbidity and mortality. Because of an increasing proportion of non-albicans Candida species and rising antifungal drug resistance, the Infectious Diseases Society of America (IDSA) changed treatment guidelines in 2016 to recommend echinocandins over fluconazole as first-line treatment for adults with candidemia. We describe candidemia treatment practices and adherence to the updated guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>During 2017\u20132018, the Emerging Infections Program conducted active population-based candidemia surveillance at 9 US sites using a standardized case definition. We assessed factors associated with initial antifungal treatment for the first candidemia case among adults using multivariable logistic regression models. To identify instances of potentially inappropriate treatment, we compared the first antifungal drug received with species and antifungal susceptibility testing (AFST) results from initial blood cultures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1835 patients who received antifungal treatment, 1258 (68.6%) received an echinocandin and 543 (29.6%) received fluconazole as initial treatment. Cirrhosis (adjusted odds ratio = 2.06; 95% confidence interval, 1.29\u20133.29) was the only underlying medical condition significantly associated with initial receipt of an echinocandin (versus fluconazole). More than one-half (n\u2005=\u2005304, 56.0%) of patients initially treated with fluconazole grew a non-albicans species. Among 265 patients initially treated with fluconazole and with fluconazole AFST results, 28 (10.6%) had a fluconazole-resistant isolate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A substantial proportion of patients with candidemia were initially treated with fluconazole, resulting in potentially inappropriate treatment for those involving non-albicans or fluconazole-resistant species. Reasons for nonadherence to IDSA guidelines should be evaluated, and clinician education is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciab512","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T16:19:00Z","timestamp":1622650740000},"page":"1609-1616","source":"Crossref","is-referenced-by-count":21,"title":["Treatment Practices for Adults With Candidemia at 9 Active Surveillance Sites\u2014United States, 2017\u20132018"],"prefix":"10.1093","volume":"73","author":[{"given":"Jeremy A W","family":"Gold","sequence":"first","affiliation":[{"name":"Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma E","family":"Seagle","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"},{"name":"ASRT Inc., Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joelle","family":"Nadle","sequence":"additional","affiliation":[{"name":"California Emerging Infections Program, Oakland, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Devra M","family":"Barter","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment, Denver, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A","family":"Czaja","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment, Denver, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Johnston","sequence":"additional","affiliation":[{"name":"Colorado Department of Public Health and Environment, Denver, Colorado, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica M","family":"Farley","sequence":"additional","affiliation":[{"name":"Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA"},{"name":"Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stepy","family":"Thomas","sequence":"additional","affiliation":[{"name":"Georgia Emerging Infections Program, Emory University School of Medicine, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee H","family":"Harrison","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Fischer","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, Saint Paul, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brittany","family":"Pattee","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, Saint Paul, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajal K","family":"Mody","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, Saint Paul, Minnesota, USA"},{"name":"Division of State and Local Readiness, Centers for Disease Control and Prevention, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin C","family":"Phipps","sequence":"additional","affiliation":[{"name":"New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Shrum","family":"Davis","sequence":"additional","affiliation":[{"name":"New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda L","family":"Tesini","sequence":"additional","affiliation":[{"name":"University of Rochester School of Medicine, Rochester, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexia Y","family":"Zhang","sequence":"additional","affiliation":[{"name":"Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffanie M","family":"Markus","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Schaffner","sequence":"additional","affiliation":[{"name":"Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn R","family":"Lockhart","sequence":"additional","affiliation":[{"name":"Mycotic 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