2111. Anidulafungin vs. Micafungin Treatment in Adult Patients with Candidemia: A Retrospective Study of Single-Center Experience

Abstract Background Candidemia is one of the fatal causes of nosocomial infection, requiring prompt recognition and treatment. Echinocandins are recommended for the treatment of invasive candidiasis and candidemia. Although similar clinical efficacy and safety are well known between caspofungin and micafungin, there are few studies comparing micafungin and anidulafungin. The objective of this study was to evaluate the clinical efficacy and safety between micafungin and anidulafungin treatment for adult patients with candidemia. Methods This retrospective cohort study was performed on adult candidemia patients diagnosed from January 2006 through December 2018 at a tertiary medical center, Seoul, South Korea. The study subjects included adult patients ≥19 years with candidemia who were only treated with micafungin or anidulafungin for more than 3 days. Baseline and clinical characteristics were reviewed through electrical medical records. Liver function was assessed according to Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. Hepatotoxicity was defined as the elevation of more than CTCAE grade 1 and severe hepatotoxicity was defined as the CTCAE grade 3 or higher elevations. Results A total of 98 patients with candidemia was treated with micafungin (n = 46, 46.9%) or anidulafungin (n = 52, 53.1%). In the univariate analysis, there were no significant differences in age, sex, source of candidemia, and comorbidities between the micafungin and anidulafungin groups. Although the clearance time of candidemia after echinocandin treatment was shorter in the anidulafungin than in the micafungin (5.64 ± 2.79 vs. 8.06 ± 5.30 days, P = 0.009) group, there was no significant difference in terms of clinical response (51.9% vs. 46.7%), mycological response (76.9% vs. 67.4%), and mortality (54.3% vs. 55.8%) between these two groups. The overall incidence of hepatotoxicity was similar. Also, there was no difference in the development of hepatotoxicity or severe hepatotoxicity between micafungin and anidulafungin groups for patients with normal baseline liver function test(LFT) and abnormal baseline LFT. Conclusion Our results suggest that clinical efficacy and hepatotoxicity may be similar between micafungin and anidulafungin treatment for adult patients with candidemia. Disclosures All authors: No reported disclosures.