Effectiveness and safety of caspofungin for the treatment of candidemia in critically ill patients with obesity: A multicenter retrospective cohort study

Given the limited evidence on the optimal caspofungin dose for patients with obesity and candidemia, this study aims to evaluate the clinical outcomes of the standard caspofungin dose in critically ill patients with obesity and 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 (BMI: 18-29.9 kg/m2) or obese (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 a P-value of <.05, and statistical analysis was conducted using SAS 9.4 software. A total of 108 patients were included; forty-six (42.6%) were obese. There were no significant differences in terms of clinical success between the groups (aOR, 1.38; 95% CI, 0.54-3.54; P = .50). Microbiological success rate was numerically higher in the control group compared to obese patients (83.9% vs. 69.6%; P = .07); notably, the difference was statistically significant in the regression analysis (aOR, 3.40; 95% CI, 1.040-11.099; P = .04). No significant differences were observed in other outcomes, including time for microbiological success, treatment failure, infection recurrence within 90 days, mortality, and length of stay. In conclusion, patients with obesity had similar clinical success to control group; however, a lower microbiological success rate was observed in patients with obesity. Further research is needed to explore long-term implications of caspofungin therapy in obese patients with candidemia.