Association of doses based on body constitutional parameters with the efficacy of micafungin in candidemia

Invasive candidiasis is a life-threatening infection associated with high mortality, necessitating early and effective treatment. Micafungin, an echinocandin, is recommended as initial therapy for invasive candidiasis. However, the optimal micafungin dose relative to patients' body constitutional parameters (BCPs) remains unclear. This study aimed to evaluate the relationship between the dose of micafungin per BCPs (Dose/BCPs) and treatment outcomes.

This two-center retrospective study included patients treated with micafungin who had confirmed positive blood cultures for Candida species between January 1, 2010, and December 31, 2020. We assessed the association between Dose/BCP and treatment success, as well as time to recovery following micafungin therapy.

Eighty-three patients were included in the analysis, with a median age of 78 years. The primary isolated Candida species were Candida albicans (n = 34), Candida parapsilosis (n = 19), and Candida glabrata (n = 16). The treatment success rate was 44.6 % and was significantly associated with age ≥75 years. Although no significant differences in Dose/BCP were observed between the success and failure groups, patients with a Dose/BSA ≥100 mg/m² experienced a significantly shorter time to recovery with micafungin therapy.

Our study identified an association between Dose/BSA and the time to recovery with micafungin therapy. While some missing data, including APACHE-II scores, limit the robustness of the findings because of the retrospective design, dose adjustment to achieve Dose/BSA ≥100 mg/m² may be beneficial in antifungal stewardship. This adjustment could reduce treatment duration with this broad-spectrum antifungal agent.