No antifungal strategy advantage found in 111 patients with chronic disseminated candidiasis
- A retrospective cohort of 111 adults with chronic disseminated candidiasis found no statistically significant association between antifungal treatment strategies and treatment response or survival.
- All-cause mortality was 33.3% (37/111), while CDC-attributable mortality was 4.5% (5/111).
- No statistically significant associations were detected between first-to-second-line treatment strategy, azole selection, and treatment response.
- Caspofungin (36.9%, 41/111) and liposomal amphotericin B (23/111; 20.7%) were the most frequently first-line agents for antifungal treatment.
- Median treatment duration was 107 days (IQR 49-182), and no CDC relapse occurred after discontinuation.
The publication
A retrospective cohort of 111 adults with chronic disseminated candidiasis found no statistically significant association between antifungal treatment strategies and treatment response or survival. All-cause mortality was 33.3% (37/111), while CDC-attributable mortality was 4.5% (5/111).
Who the findings apply to
The study included adults with possible, probable, or proven chronic disseminated candidiasis diagnosed between 2007 and 2025.
Patients were identified through the FungiScope registry and collaborating networks in 19 countries.
The cohort comprised 111 patients, with CDC classified as possible in 23.4% (n = 26), probable in 50.5% (n = 56), and proven in 26.1% (n = 29).
Why this matters
Treatment recommendations for chronic disseminated candidiasis rely on limited observational data, and the impact of widespread antifungal prophylaxis on outcomes remains poorly characterized. This study aimed to comprehensively characterize the condition and explore associations between treatment strategies and clinical outcomes in the era of antifungal prophylaxis.
What the study found
No statistically significant associations were detected between first-to-second-line treatment strategy, azole selection, and treatment response.
Caspofungin (36.9%, 41/111) and liposomal amphotericin B (23/111; 20.7%) were the most frequently first-line agents for antifungal treatment.
Median treatment duration was 107 days (IQR 49-182), and no CDC relapse occurred after discontinuation.
All-cause mortality was 33.3% (37/111), and CDC-attributable mortality was 4.5% (5/111).
In an exploratory observational comparison, overall survival was higher among patients with breakthrough CDC than without (88.9% vs 58.5%; p = 0.004).
Breakthrough CDC occurred in 24.8% (27/109) of patients, and PET/CT was used in 26.1% (n = 29) of patients for follow-up.
What the result does not establish
The study was a retrospective, multinational cohort study, and comparative treatment analyses were exploratory.
The study was not powered to exclude clinically meaningful differences between antifungal strategies.
The predominant species were Candida albicans (32.4%, n = 36) and Candida tropicalis (24.3%, n = 27); no species was identified in 30.6% (n = 34).
Corticosteroids for immune reconstitution inflammatory syndrome were used in 4.5% of patients.
Authors’ conclusion
“No statistically significant associations between antifungal treatment strategy and treatment response or survival were detected in this retrospective dataset. However, the comparative treatment analyses were exploratory and the study was not powered to exclude clinically meaningful differences between antifungal strategies. Median treatment duration was shorter than previously reported. Future prospective studies…”
Study and sources
Treatment and outcome of chronic disseminated candidiasis in the era of antifungal prophylaxis: a retrospective multicentre cohort of 111 patients
Real-world / observational study · EClinicalMedicine · 2026-09-16
Sources and limitations
- PubMed record PMID 42774582 (PubMed / NLM · 2026-09-25)
- Trial registry NCT01731353 (ClinicalTrials.gov · 2026-09-25)
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