Effectiveness and Safety of Caspofungin for the Treatment of Candidemia in critically ill patients with obesity: A Multicenter Retrospective Cohort Study.

In critically ill patients, obesity frequently results in changes to caspofungin pharmacokinetic parameters. Given the limited evidence available regarding the optimal dosing strategy for critically ill patients with obesity and candidemia, this study aims to evaluate the clinical outcomes of caspofungin standard dose in critically ill patients with obesity and confirmed candidemia. A multicenter, retrospective cohort study was conducted in three tertiary care hospitals in Saudi Arabia. Eligible critically ill patients with confirmed candidemia who received standard dose of caspofungin were stratified according to their Body Mass Index (BMI) at the time of caspofungin initiation into two groups: control (whose BMI was 18 - 29.9 kg/m2) or obese (whose BMI≥ 30 kg/m2). The primary outcome was the incidence of clinical success. All other outcomes were considered secondary. The significance level was set at p-value < 0.05 and statistical analysis was conducted using SAS 9.4 software. A total of 108 patients were included, 46 (42.6%) of whom were obese. There were no statistically significant differences in terms of clinical success between the groups (OR 1.38 (0.54, 3.54), p-value = 0.50). The microbiological success rate was numerically lower in the obese group (69.6% vs 83.9%; p-value = 0.07), notably, the difference was statistically significant in regression analysis (OR 3.40; p-value = 0.04; 95% CI, 1.040, 11.099). No significant differences were observed in all other outcomes including time for clinical success, time for microbiological success, clinical failure, infection recurrence within 90 days, in-hospital mortality, 30-day mortality, hospital and ICU length of stay. In terms of safety outcomes, both groups had a comparable incidence rate of adverse drug reactions. Our study revealed that patients with obesity had similar clinical success to non-obese patients. However, the microbiological success rate was lower in patients with obesity who received caspofungin standard dose. Further research is needed to validate these results and explore the long-term implications of caspofungin therapy in obese patients with candidemia.