{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T08:01:42Z","timestamp":1785484902824,"version":"3.56.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100031015","name":"Hospital Clinic of Barcelona","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100031015","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Invasive candidiasis (IC) carries high mortality; although guidelines recommend echinocandins followed by de-escalation (DES) to azoles in stable patients, the optimal timing, particularly for early (\u22645 days) step-down, remains uncertain due to limited prospective evidence. This study evaluates the safety and outcomes of early (\u22645 days) antifungal de-escalation (DES) versus standard therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single-centre prospective study during 17 months in adults with candidemia or intra-abdominal candidiasis (IAC) receiving initial echinocandin therapy. Early (\u22645 days) DES was compared with continued echinocandin therapy (non-DES). The primary outcome was 30-day global response; secondary outcomes included mortality at end of treatment (EoT), recurrence, length of stay, microbiological outcomes and antifungal consumption\/costs. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 152 screened patients, 114 with IC (80 candidemia, 34 IAC) were included; 55.3% underwent DES, mainly to fluconazole (95.2%), at a median of 4 days. The 30-day global response was higher with DES but not statistically significant (60.3% versus 45.1%, P\u200a=\u200a0.105). However, DES was associated with higher clinical success at EoT (79.4% versus 58.8%, P\u200a=\u200a0.017) and lower EoT mortality (11.1% versus 29.4%, P\u200a=\u200a0.014). After IPTW adjustment, DES was not associated with improved 30-day global response. In candidemia, DES improved 30-day response (65.1% versus 43.2%, P\u200a=\u200a0.049), whereas no differences were observed in IAC. Early DES reduced antifungal costs by 77.4% per \/candidemia episode.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early DES in clinically stable IC patients with source control was safe and not associated with worse outcomes, supporting its use in stewardship programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag252","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:59:02Z","timestamp":1783684742000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of an early step-down (\u22645 days) strategy from echinocandins to azole therapy for the treatment of invasive candidiasis"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3223-670X","authenticated-orcid":false,"given":"M","family":"Albanell-Fern\u00e1ndez","sequence":"first","affiliation":[{"name":"Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Universitat de Barcelona , Barcelona ,","place":["Spain"]},{"name":"Department of Physiological Science, School of Medicine, Universitat de Barcelona, L'Hospitalet de Llobregat , Barcelona ,","place":["Spain"]},{"name":"Institut d'Investigaci\u00f3 Biom\u00e8dica August Pi i Sunyer (IDIBAPS) , Barcelona ,","place":["Spain"]},{"name":"Faculty of Medicine, University of Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Tuset","sequence":"additional","affiliation":[{"name":"Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Vergara","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Hospital Clinic-CDB, Universitat de Barcelona , Barcelona ,","place":["Spain"]},{"name":"Institute of Global Health (ISGlobal) , Barcelona ,","place":["Spain"]},{"name":"CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Villanueva","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Barrantes-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Pharmacy Service, Division of Medicines, Hospital Clinic of Barcelona, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Bodro","sequence":"additional","affiliation":[{"name":"Institut d'Investigaci\u00f3 Biom\u00e8dica August Pi i Sunyer (IDIBAPS) , Barcelona ,","place":["Spain"]},{"name":"Faculty of Medicine, University of Barcelona , Barcelona ,","place":["Spain"]},{"name":"CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"Department of Infectious Diseases, Hospital Clinic of Barcelona, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9374-0811","authenticated-orcid":false,"given":"A","family":"Soriano","sequence":"additional","affiliation":[{"name":"Institut d'Investigaci\u00f3 Biom\u00e8dica August Pi i Sunyer (IDIBAPS) , Barcelona ,","place":["Spain"]},{"name":"Faculty of Medicine, University of Barcelona , Barcelona ,","place":["Spain"]},{"name":"CIBER Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"Department of Infectious Diseases, Hospital Clinic of Barcelona, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Herrera","sequence":"additional","affiliation":[{"name":"Institut d'Investigaci\u00f3 Biom\u00e8dica August Pi i Sunyer (IDIBAPS) , Barcelona ,","place":["Spain"]},{"name":"Faculty of Medicine, University of Barcelona , Barcelona ,","place":["Spain"]},{"name":"Department of Infectious Diseases, Hospital Clinic of Barcelona, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"2026073103544090900_dkag252-B1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-14-97","article-title":"Evaluation of an early step-down strategy from intravenous anidulafungin to oral azole therapy for the treatment of candidemia and other forms of invasive candidiasis: results from an open-label trial","volume":"14","author":"Vazquez","year":"2014","journal-title":"BMC Infect Dis"},{"key":"2026073103544090900_dkag252-B2","doi-asserted-by":"publisher","first-page":"O245","DOI":"10.1111\/1469-0691.12380","article-title":"Epidemiology and predictive factors for early and late mortality in Candida bloodstream infections: a population-based surveillance in Spain","volume":"20","author":"Puig-Asensio","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2026073103544090900_dkag252-B3","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1093\/jac\/dks347","article-title":"Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. Bloodstream infections","volume":"68","author":"Garnacho-Montero","year":"2013","journal-title":"J Antimicrob Chemother"},{"issue":"Suppl 6","key":"2026073103544090900_dkag252-B4","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/1469-0691.12622","article-title":"Antifungal stewardship in invasive Candida infections","volume":"20","author":"Ruhnke","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"2026073103544090900_dkag252-B5","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1093\/jac\/dkad139","article-title":"Invasive candidiasis: current clinical challenges and unmet needs in adult populations","volume":"78","author":"Soriano","year":"2023","journal-title":"J Antimicrob Chemother"},{"key":"2026073103544090900_dkag252-B6","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2015","journal-title":"Clin Infect Dis"},{"key":"2026073103544090900_dkag252-B7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/1469-0691.12039","article-title":"ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients","volume":"18 Suppl 7","author":"Cornely","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2026073103544090900_dkag252-B8","doi-asserted-by":"publisher","first-page":"e280","DOI":"10.1016\/S1473-3099(24)00749-7","article-title":"Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM","volume":"25","author":"Cornely","year":"2025","journal-title":"Lancet Infect Dis"},{"key":"2026073103544090900_dkag252-B9","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1093\/cid\/ciy827","article-title":"Isavuconazole versus caspofungin in the treatment of candidemia and other invasive Candida infections: the ACTIVE trial","volume":"68","author":"Kullberg","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2026073103544090900_dkag252-B10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-11-261","article-title":"Anidulafungin compared with fluconazole for treatment of candidemia and other forms of invasive candidiasis caused by Candida albicans: a multivariate analysis of factors associated with improved outcome","volume":"11","author":"Reboli","year":"2011","journal-title":"BMC Infect Dis"},{"key":"2026073103544090900_dkag252-B11","doi-asserted-by":"publisher","first-page":"e0013725","DOI":"10.1128\/aac.00137-25","article-title":"Antibiofilm activity of manogepix, ibrexafungerp, amphotericin B, rezafungin, and caspofungin against Candida spp. Biofilms of reference and clinical strains","volume":"69","author":"Ceballos-Garzon","year":"2025","journal-title":"Antimicrob Agents Chemother"},{"key":"2026073103544090900_dkag252-B12","doi-asserted-by":"publisher","first-page":"4377","DOI":"10.1128\/AAC.00316-09","article-title":"Biofilm formation and effect of caspofungin on biofilm structure of Candida Species bloodstream isolates","volume":"53","author":"Ferreira","year":"2009","journal-title":"Antimicrob Agents Chemother"},{"key":"2026073103544090900_dkag252-B13","doi-asserted-by":"publisher","first-page":"e2021031","DOI":"10.4084\/MJHID.2021.031","article-title":"Timing for step-down therapy of candidemia in non-neutropenic patients: an international multi-center study","volume":"13","author":"Husni","year":"2021","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"2026073103544090900_dkag252-B14","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.ijid.2022.04.044","article-title":"De-escalation from echinocandins to azole treatment in critically ill patients with candidemia","volume":"121","author":"Lin","year":"2022","journal-title":"Int J Infect Dis"},{"key":"2026073103544090900_dkag252-B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107020","article-title":"Clinical evaluation of antifungal de-escalation in Candida infections: a systematic review and meta-analysis","volume":"143","author":"Albanell-Fern\u00e1ndez","year":"2024","journal-title":"Int J Infect Dis"},{"key":"2026073103544090900_dkag252-B16","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/CCM.0000000000002867","article-title":"Initial antifungal strategy reduces mortality in critically ill patients with candidemia: a propensity score-adjusted analysis of a multicenter study","volume":"46","author":"Garnacho-Montero","year":"2018","journal-title":"Crit Care Med"},{"key":"2026073103544090900_dkag252-B17","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/ijcp.12231","article-title":"Antifungal step-down therapy based on hospital intravenous to oral switch policy and susceptibility testing in adult patients with candidaemia: a single centre experience","volume":"68","author":"Bal","year":"2014","journal-title":"Int J Clin Pract"},{"key":"2026073103544090900_dkag252-B18","doi-asserted-by":"publisher","first-page":"1931","DOI":"10.1007\/s00134-015-4053-1","article-title":"Antifungal de-escalation was not associated with adverse outcome in critically ill patients treated for invasive candidiasis: post hoc analyses of the AmarCAND2 study data","volume":"41","author":"Bailly","year":"2015","journal-title":"Intensive Care Med"},{"key":"2026073103544090900_dkag252-B19","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab250","article-title":"Early stepdown from echinocandin to fluconazole treatment in candidemia: a post hoc analysis of three cohort studies","volume":"8","author":"Moreno-Garc\u00eda","year":"2021","journal-title":"Open Forum Infect Dis"},{"key":"2026073103544090900_dkag252-B20","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1111\/myc.12450","article-title":"Echinocandin to fluconazole step-down therapy in critically ill patients with invasive, susceptible Candida albicans infections","volume":"59","author":"van der Geest","year":"2016","journal-title":"Mycoses"},{"key":"2026073103544090900_dkag252-B21","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1093\/jac\/dkaf026","article-title":"Fluconazole step-down therapy versus echinocandins for the treatment of Candida glabrata invasive candidiasis with candidaemia","volume":"80","author":"Droney","year":"2025","journal-title":"J Antimicrob Chemother"},{"key":"2026073103544090900_dkag252-B22","author":"European Committee on Antimicrobial Susceptibility Testing (EUCAST)"},{"key":"2026073103544090900_dkag252-B23","author":"WHO Collaborating Centre for Drug Statistics Methodology"},{"key":"2026073103544090900_dkag252-B24","author":"Consejo General de Colegios Oficiales de Farmac\u00e9uticos"},{"key":"2026073103544090900_dkag252-B25","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1111\/myc.12094","article-title":"An open-label study of anidulafungin for the treatment of candidaemia\/invasive candidiasis in Latin America","volume":"57","author":"Nucci","year":"2014","journal-title":"Mycoses"},{"key":"2026073103544090900_dkag252-B26","doi-asserted-by":"publisher","first-page":"763","DOI":"10.2147\/CEOR.S141548","article-title":"\u201cDe-escalation\u201d strategy using micafungin for the treatment of systemic Candida infections: budget impact in France and Germany","volume":"9","author":"Van Engen","year":"2017","journal-title":"Clinicoecon Outcomes Res"},{"key":"2026073103544090900_dkag252-B27","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1080\/13696998.2017.1417312","article-title":"Cost-effectiveness of de-escalation from micafungin versus escalation from fluconazole for invasive candidiasis in China","volume":"21","author":"Chen","year":"2018","journal-title":"J Med Econ"},{"key":"2026073103544090900_dkag252-B28","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1093\/jac\/dkp131","article-title":"Outcomes of early switching from intravenous to oral antibiotics on medical wards","volume":"64","author":"Mertz","year":"2009","journal-title":"J Antimicrob Chemother"},{"key":"2026073103544090900_dkag252-B29","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s13613-018-0392-8","article-title":"De-escalation of antifungal treatment in critically ill patients with suspected invasive Candida infection: incidence, associated factors, and safety","volume":"8","author":"Jaffal","year":"2018","journal-title":"Ann Intensive Care"},{"key":"2026073103544090900_dkag252-B30","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciag252","article-title":"Candida glabrata emerges as the most common cause of candidemia: analysis of a large hospital-based database, United States, 2016\u20132024","author":"Gold","year":"2026","journal-title":"Clin Infect Dis"},{"key":"2026073103544090900_dkag252-B31","doi-asserted-by":"publisher","DOI":"10.1093\/jambio\/lxae037","article-title":"An integrated method for targeted Oxford Nanopore sequencing and automated bioinformatics for the simultaneous detection of bacteria, fungi, and ARG","volume":"135","author":"Kuruwa","year":"2024","journal-title":"J Appl Microbiol"},{"key":"2026073103544090900_dkag252-B32","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.001990","article-title":"Evaluation of whole-genome sequencing protocols for detection of antimicrobial resistance, virulence factors and mobile genetic elements in antimicrobial-resistant bacteria","volume":"74","author":"Cipriani","year":"2025","journal-title":"J Med Microbiol"},{"key":"2026073103544090900_dkag252-B33","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/S0140-6736(22)02324-8","article-title":"Rezafungin versus caspofungin for treatment of candidaemia and invasive candidiasis (ReSTORE): a multicentre, double-blind, double-dummy, randomised phase 3 trial","volume":"401","author":"Thompson","year":"2023","journal-title":"Lancet"},{"key":"2026073103544090900_dkag252-B34","doi-asserted-by":"publisher","first-page":"e3647","DOI":"10.1093\/cid\/ciaa1380","article-title":"Rezafungin versus caspofungin in a phase 2, randomized, double-blind study for the treatment of candidemia and invasive candidiasis: the STRIVE trial","volume":"73","author":"Thompson","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2026073103544090900_dkag252-B35","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02307-20","article-title":"Prospective cohort study of micafungin population pharmacokinetic analysis in plasma and peritoneal fluid in septic patients with intra-abdominal infections","volume":"65","author":"Garbez","year":"2021","journal-title":"Antimicrob Agents Chemother"},{"key":"2026073103544090900_dkag252-B36","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.ijid.2019.07.008","article-title":"Pharmacokinetics of anidulafungin in critically ill patients with Candida peritonitis","volume":"86","author":"P\u00e9rez Civantos","year":"2019","journal-title":"Int J Infect Dis"},{"key":"2026073103544090900_dkag252-B37","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.ijid.2020.09.019","article-title":"Pharmacokinetics of echinocandins in suspected Candida peritonitis: a potential risk for resistance","volume":"101","author":"Gioia","year":"2020","journal-title":"Int J Infect Dis"},{"key":"2026073103544090900_dkag252-B38","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1128\/AAC.00296-07","article-title":"Correlation of the MIC and dose\/MIC ratio of fluconazole to the therapeutic response of patients with mucosal candidiasis and candidemia","volume":"51","author":"Rodr\u00edguez-Tudela","year":"2007","journal-title":"Antimicrob Agents Chemother"},{"key":"2026073103544090900_dkag252-B39","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1111\/j.1469-0691.2007.01899.x","article-title":"EUCAST technical note on fluconazole","volume":"14","author":"European Committee on Antimicrobial Susceptibility Testing-Subcommittee on Antifungal Susceptibility Testing (EUCAST-AFST)","year":"2008","journal-title":"Clin Microbiol Infect"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/81\/8\/dkag252\/70406393\/dkag252.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/81\/8\/dkag252\/70406393\/dkag252.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T07:54:48Z","timestamp":1785484488000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/doi\/10.1093\/jac\/dkag252\/8748019"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":39,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkag252","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,2]]},"article-number":"dkag252"}}