{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:50:26Z","timestamp":1790740226621,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014419","name":"EIT Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014419","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010686","name":"European Institute of Innovation and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010686","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Union\u00b4s Horizon 2020 Research and Innovation Program"},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["PI18\/01061"],"award-info":[{"award-number":["PI18\/01061"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["CM18\/00132"],"award-info":[{"award-number":["CM18\/00132"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["CP18\/00073"],"award-info":[{"award-number":["CP18\/00073"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["FIS PI18\/01061"],"award-info":[{"award-number":["FIS PI18\/01061"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Ministerio de Sanidad y Consumo"},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>There are no clear criteria for antifungal de-escalation after initial empirical treatments. We hypothesized that early de-escalation (ED) (within 5 days) to fluconazole is safe in fluconazole-susceptible candidemia with controlled source of infection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This is a multicenter post hoc study that included consecutive patients from 3 prospective candidemia cohorts (2007\u20132016). The impact of ED and factors associated with mortality were assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1023 candidemia episodes, 235 met inclusion criteria. Of these, 54 (23%) were classified as the ED group and 181 (77%) were classified as the non-ED group. ED was more common in catheter-related candidemia (51.9% vs 31.5%; P\u2005=\u2005.006) and episodes caused by Candida parapsilosis, yet it was less frequent in patients in the intensive care unit (24.1% vs 39.2%; P\u2005=\u2005.043), infections caused by Nakaseomyces glabrata (0% vs 9.9%; P\u2005=\u2005.016), and candidemia from an unknown source (24.1% vs 47%; P\u2005=\u2005.003). In the ED and non-ED groups, 30-day mortality was 11.1% and 29.8% (P\u2005=\u2005.006), respectively. Chronic obstructive pulmonary disease (odds ratio [OR], 3.97; 95% confidence interval [CI], 1.48\u201310.61), Pitt score\u2005&amp;gt;\u20052 (OR, 4.39; 95% CI, 1.94\u20139.20), unknown source of candidemia (OR, 2.59; 95% CI, 1.14\u20135.86), candidemia caused by Candida albicans (OR, 3.92; 95% CI, 1.48\u201310.61), and prior surgery (OR, 0.29; 95% CI, 0.08\u20130.97) were independent predictors of mortality. Similar results were found when a propensity score for receiving ED was incorporated into the model. ED had no significant impact on mortality (OR, 0.50; 95% CI, 0.16\u20131.53).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Early de-escalation is a safe strategy in patients with candidemia caused by fluconazole-susceptible strains with controlled source of bloodstream infection and hemodynamic stability. These results are important to apply antifungal stewardship strategies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofab250","type":"journal-article","created":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T19:38:26Z","timestamp":1621193906000},"source":"Crossref","is-referenced-by-count":23,"title":["Early Stepdown From Echinocandin to Fluconazole Treatment in Candidemia: A Post Hoc Analysis of Three Cohort Studies"],"prefix":"10.1093","volume":"8","author":[{"given":"E","family":"Moreno-Garc\u00eda","sequence":"first","affiliation":[{"name":"Hospital Cl\u00ednic, Universitat de Barcelona , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2490-0217","authenticated-orcid":false,"given":"P","family":"Puerta-Alcalde","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic, Universitat de Barcelona , Barcelona , 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